doppler ultrasound of normal venous flow
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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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