Peripheral Venous Evaluations
Patients are referred for a Lower Extremity Venous Evaluation for suspected acute deep vein thrombosis (DVT) and/or superficial vein thrombosis, suspected pulmonary embolism, or suspicion of embolic CVA. Patients are also seen for follow-up evaluations of a known DVT to document progression or resolution of the thrombotic process.
Pacific Vascular offers 3 different exams for the diagnosis of lower extremity venous thrombosis:
Complete – Lower Extremity + Iliocaval Duplex
Bilateral duplex ultrasound of the iliocaval, femoropopliteal, tibial and great saphenous veins.
Conditional – Lower Extremity + Iliocaval Duplex prn
- Bilateral duplex ultrasound of the femoropopliteal, tibial and great saphenous veins.
- Bilateral duplex of the iliocaval veins when the patient presents with any of the following:
- Symptoms
- Pulmonary Embolism (PE) symptoms or clinical suspicion of PE
- Shortness of breath
- Chest pain
- Fever of unknown origin
- Dyspnea
- Hemoptysis
- Abnormal V/Q or CTA scans
- Respiratory Distress
- Suspicion of embolic CVA
- Known hypercoagulopathy
- Patient history of DVT
- DVT or SVT in the symptomatic leg
- Bilateral symptoms
- IVC filter present in patient
- Pulmonary Embolism (PE) symptoms or clinical suspicion of PE
- Risk Factors
- Immobilization (prolonged bed rest or other instances of extended inactivity, such as a long car or plane ride)
- Recent surgery
- Ultrasound Findings
- Abnormal common femoral vein Doppler waveforms indicating proximal obstruction.
- Symptoms
Abbreviated – Lower Extremity Duplex Only
Bilateral duplex of the femoropopliteal, tibial and saphenous veins.
Clinical Indications for DVT
- Limb pain, swelling, or tenderness
- Limb cyanosis and/or erythema
- Symptoms of pulmonary embolus
- Shortness of breath
- Chest pain
- Dyspnea
- Hemoptysis
- Abnormal V/Q or CTA scans
- Respiratory distress
- Fever of unknown origin
- Suspicion of embolic CVA (CVA of unknown origin)
Duplex/color ultrasound scanning is utilized to evaluate the abdominal and pelvic veins and the deep and superficial veins of the lower extremities for venous obstruction.
Routinely examined are the bilateral common femoral veins, femoral veins, popliteal veins, gastrocnemius veins, common tibioperoneal trunk veins, posterior tibial veins, peroneal veins and great saphenous veins. The anterior tibial veins, small saphenous veins, soleal veins, perforating veins and other veins are evaluated if suspected of thrombosis. Examinations are performed bilaterally unless the patient presents with unilateral symptoms, there are no positive acute thrombotic findings, has no significant risk factors of DVT, and a unilateral examination is specifically requested by the referring physician.
Upper Extremity Venous Evaluations are typically ordered when a patient presents with acute pain and/or swelling and sometimes discoloration often at or around a PICC line site or following injury or other trauma to the upper limb, and venous thrombosis is suspected. Symptoms and risk factors are similar to that of the Lower Extremity Venous evaluation.
Clinical indications include:
- Limb pain
- Swelling
- Tenderness or suspected PE
Duplex/Color ultrasound scanning is utilized to evaluate the distal innominate, internal jugular, subclavian, axillary, brachial, radial, ulnar, basilic, and cephalic veins. Examinations are performed bilaterally unless otherwise requested.
A lower extremity reflux exam is ordered if a patient has symptoms of venous insufficiency or varicose veins to evaluate the presence of venous reflux.
Symptoms of venous reflux can include:
- Leg pain, aching or cramping
- Burning or itching of skin
- Leg or ankle swelling
- “Heavy” feeling in legs
- Skin discoloration or texture changes above inner ankle (hyperpigmentation)
- Restless legs
- Venous ulcers (open wounds or sores above inner ankle)
Venous reflux disease, also known as valvular incompetency or venous insufficiency, is a condition that develops when the valves that usually keep blood flowing out of your legs become damaged or diseased. These valves that normally force blood back towards the heart no longer function, causing blood to pool up in the legs, and the veins to the legs become distended.
Duplex ultrasound measures valve closure time and diameter to diagnosis the presence or absence of reflux in the deep, superficial and perforating veins of the lower extremity. This exam is an insurance requirement for the treatment of venous insufficiency or varicose veins, such as radiofrequency or laser ablation.
Most commonly ordered 48-72 hours after a venous ablation procedure. The duplex exam confirms the level of vein closure and an evaluation for the complication of DVT post-ablation. Usually unilateral, unless both lower extremities were treated on the same day.
The saphenous veins and other superficial veins are often used for coronary or peripheral arterial bypass graft surgery.
The vein requested is imaged then marked and mapped on the skin surface. Periodic diameter measurements as well as venous flow samples are taken and reported to the surgeon. Other findings of interest may include vessel course, useable length of vein, tortuosity or varicosities, location of valves, side branches, duplicates, sclerosis or thrombosis.
The surgeon notifies the technologist of the type of surgical procedure and specifies which limbs are to be mapped and/or marked.
