doppler ultrasound of normal venous flow

Doppler ultrasound of normal venous flow

Samir Haffar M.D.

Normal venous flow

Spontaneity Spontaneous flow without augmentation

Phasicity Flow changes with respiration

Compression Transverse plane

Augmentation Compression distal to site of examination

Patency below site of examination

Valsalva Deep breath, strain while holding breath Patency of abdominal & pelvic veins

Normal venous flow

Spontaneity Spontaneous flow without augmentation

Phasicity Flow changes with respiration

Compression Transverse plane

Augmentation Compression distal to site of examination

Patency below site of examination

Valsalva Deep breath, strain while holding breath Patency of abdominal & pelvic veins

Normal venous flow

Spontaneity Spontaneous flow without augmentation

Phasicity Flow changes with respiration

Compression Transverse plane

Augmentation Compression distal to site of examination

Patency below site of examination

Valsalva Deep breath, strain while holding breath Patency of abdominal & pelvic veins

PhasicityFlow changes with respiration

Slow ApneaRapid

Normal venous flow

Spontaneity Spontaneous flow without augmentation

Phasicity Flow changes with respiration

Compression Transverse plane

Augmentation Compression distal to site of examination

Patency below site of examination

Valsalva Deep breath, strain while holding breath Patency of abdominal & pelvic veins

Compressibility of veins

Do not press too hard since the normal vein collapsesvery easily making it difficult to find

External compression of the veins

CompressionRelaxation

Incompressibility = Thrombus

Do not compress vein more than necessary in acute thrombusFear of detaching thrombus to cause PE

Myers KA & Clough A. Making sense of vascular ultrasound. Arnold, London, 2004 .

Transverse compression of veins

Normal vein Complete collapse

Nonocclusive thrombosed veinPartial collapse

Completely thrombosed veinNo collapse

Hamper UM et al. Radiol Clin N Am 2007 ; 45 : 525 – 547.

Normal venous flow

Spontaneity Spontaneous flow without augmentation

Phasicity Flow changes with respiration

Compression Transverse plane

Augmentation Compression distal to site of examination

Patency below site of examination

Valsalva Deep breath, strain while holding breath Patency of abdominal & pelvic veins

Augmented flow in popliteal vein

Aug Valve closed

Competent vein

Normal venous flow

Spontaneity Spontaneous flow without augmentation

Phasicity Flow changes with respiration

Compression Transverse plane

Augmentation Compression distal to site of examination

Patency below site of examination

Valsalva Deep breath, strain while holding breath Patency of abdominal & pelvic veins

Valsalva’s maneuver

A V

At rest

A V

Valsalva

Valsalva’s maneuver

End Valsalva

Start Valsalva

Competent vein

Venous valve

Two cups of a valve clearly seenIt is uncommon to see venous valves with this clarityStasis of blood evident behind one of the valve cups

Venous reflux

Significant venous refluxof > 2 sec duration

Augmentationor Valsalva

Grading of venous reflux

Grade

Reflux duration

Normal valve function Reflux duration of < 0.5 sec Rapid closure of venous valves

Moderate reflux Reflux duration of 0.5 – 1 sec Mild to moderate retrograde flow

Significant reflux Reflux duration of > 1 sec Large volume of retrograde flow

Thrush A, Hartshorne T. Peripheral vascular ultrasound: How, why and when.Elsevier Churchill Livingstone, London, 2nd edition, 2005 .

Venous stasis

Echogenic speckle pattern of a deep calf veinMovement of blood is visible in real time

Echogenic Blood

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