Rt 255 Spring rev 2010 Week 2 - 2014 D. Charman Venography The blood-vascular system consists basically of the heart, arteries, capillaries, and veins. The heart serves as a pumping mechanism to keep the blood in constant circulation throughout the vast system of blood vessels. Arteries convey the blood away from the heart. Veins convey the blood back toward the heart. Purpose Anatomy Pathology Veno Procedure Contrast Patient Care Other Modalities & Procedures Rt 255 Spring rev 2010 Week 2 - 2014 D. Charman

Vein anatomy – lower ext

Purpose of Venography Venography is an x-ray exam that provides an image of the veins (leg) after a contrast is injected into a vein in the patient's foot Enables the condition of the deep leg veins to be assessed Primarily performed to diagnose deep vein thrombosis DVT LOWER LIMB VENOGRAMS Lower limb venography is common and is usually performed to rule out thrombosis of the deep veins of the leg. Venograms are usually obtained with contrast medium injected through a needle placed directly into a superficial vein in the foot.

Indications Distinguish blood clots from obstructions in the veins Evaluate congenital vein problems Assess the functioning of deep leg vein valves Identify a vein for arterial bypass grafting (CABG) Diagnose deep vein thrombosis , a blood clot deep within the leg that may lead to an obstruction of a blood vessel in the lungs ( pulmonary embolism ) Distinguish blood clots from obstructions in the veins Evaluate congenital vein problems Assess the functioning of deep leg vein valves Identify a vein for arterial bypass grafting

Deep vein thrombosis (DVT) is a common but elusive illness that can result in suffering and death if not recognized and treated effectively. DVT occurs in ~2 million Americans each year. Death can occur when the venous thrombi break off and form pulmonary emboli, which pass to and obstruct the arteries of the lungs. DVT and pulmonary embolism (PE) most often complicate the course of sick, hospitalized patients but may also affect ambulatory and otherwise healthy persons.

DVT Deep vein thrombosis is a major complication in orthopedic surgical patients and patients with cancer and other chronic illnesses. DVT can be a chronic disease. Patients who survive the initial episode of DVT are prone to chronic swelling of the leg and pain because the valves in the veins can be damaged by the thrombotic process, leading to venous hypertension.

LOWER LIMB DVT Venous thrombosis in the lower limb can involve the superficial leg veins, the deep veins of the calf (calf vein thrombosis), the more proximal veins, including popliteal veins, the superficial femoral, common femoral, and iliac veins. Less commonly, thrombosis involves other veins in the body

PE It is estimated that each year 600, 000 patients develop PE and that 60,000 die of this complication. This number exceeds the number of American women who die each year from breast cancer. PE is now the most frequent cause of death associated with childbirth. Women are a prime target for PE, being affected more often than men.

Pulmonary Embolism Occurs when a clot forms or becomes lodged in the pulmonary artery Most commonly thrombus originates in the lower limbs and migrates Can lead to resp distress, heart failure or cardiogenic shock Symptoms are acute: Sudden coughing SOB Chest pain

DVT & PE DVT usually occurs in lower leg. Impedes normal blood flow. DVT is stationary. PE is the result of a DVT breaking apart.

The Danger of PE’s 3rd leading cause of cardiovascular death in U.S.

Pulmonary embolism

Venous Thrombosis CH 8 Pathology venous thrombosis- the formation of blood clots within a vein These clots commonly form in the veins of the lower extremities and result from a slowing of the blood return to the heart. The contraction of the leg muscles assists with venous blood return; therefore, postoperative or bedfast patients are especially prone to this disorder. Phlebitis, an inflammation of the vein, is often associated with venous thrombosis - the combination of these disorders is thrombophlebitis. The thrombus formation generally begins in the valves of the deep calf veins where thromboplastin traps red blood cells to create the blood clot. Patients may be placed on anticoagulant drugs or receive thrombolytic therapy. VENOUS THROMBOSIS The formation of blood clots within a vein is called venous thrombosis. These clots commonly form in the veins of the lower extremities (Fig. 8-56) and result from a slowing of the blood return to the heart. The contraction of the leg muscles assists with venous blood return; therefore, postoperative or bedfast patients are especially prone to this disorder. Phlebitis, an inflammation of the vein, is often associated with venous thrombosis. The medical term used to specify the combination of these disorders is thrombophlebitis. The thrombus formation generally begins in the valves of the deep calf veins where thromboplastin traps red blood cells to create the blood clot. Patients may be placed on anticoagulant drugs or receive thrombolytic therapy. (Mace, James D.. Radiographic Pathology for Technologists, 4th Edition. C.V. Mosby, 022004. 8.11). <vbk:0-323-01893-9#outline(8.11)>

Cause Incidence Phlebitis Thrombus Thrombophlebitis Venous Thrombosis

Deep Vein Thrombosis Primarily involves lower limbs Major source of fatal PE Risks Restricted mobility Surgery Obesity Pregnant BC pills Long trips Plane Car Deep Venous Thrombosis DVT, which primarily involves the lower extremities, is the major source of potentially fatal pulmonary embolism. the patient's leg should not be massaged to decrease edema. If DVT exists, the pressure applied could cause a thrombus to break free, becoming an embolus.

Thrombosis & Embolism Intravascular clot Commonly in veins more than arteries 3 factors Where blood is slow Change in the wall of vessels Change in the blood itself Thrombus that becomes detached from the vessel wall Can easily flow to heart causing PE Severity depends on location of embolism

DVT & Phlebitis - Embolus

DVT 2 weeks after having a Rt knee arthroscopy, I began to develop pain in my rt calf – no problems with kright knee, but it was becoming difficult to walk because of the calf pain. Then my grandmother passed away, so I took a 3 hour plane ride to Missouri and back. On the plane ride back - my calf started swelling even more. By the time I landed I was not able to walk off the plane due to the leg pain, and was also experiencing some SOB. I was sent to the hospital, underwent a venogram and US where a blood clot was dx. A current student of mine performed the venogram. What was the course of treatment I received? Nuc Med scan and CT chest to R/O PE A course of Coumadin Compression stocking, bed rest

Deep Vein Thrombosis

DVT

Varicose Veins Dilated, elongated and tortuous vessels Most common to superficial veins of leg Multiple bluish nodules just under skin Development of collateral veins What Causes Varicose Veins? Weak or damaged valves in the veins can cause varicose veins. The veins in the legs must work against gravity to return to blood towards the heart. One-way valves inside the veins open to let blood flow through and then shut to keep blood from flowing backward. If the valves are weak or damaged, blood can back up and pool in the4 veins. This causes the veins to swell. Weak valves may be due to weak vein walls. When the walls of the veins are weak, they lose their normal elasticity. They become like an overstretched rubber band. This makes the walls of the veins longer and wider and causes the flaps of the valves to separate. When the valve flaps separate, blood can flow backward through the valves. The backflow of blood fills the veins and stretches the walls even more. As a result, the veins get bigger, swell, and often get twisted as they try to squeeze into their normal space.

Varicose Veins Valves are unable to prevent backflow Valves cease to function increasing blood volume is these veins The signs and symptoms of varicose veins include: Large veins that you can see on your skin. Mild swelling of ankles and feet. Painful, achy, or "heavy" legs. Throbbing or cramping in the legs. Itchy legs, especially on the lower leg and ankle. This is sometimes incorrectly diagnosed as dry skin. Discolored skin in the area around the varicose vein Diagnostic Tests and Procedures Doppler Ultrasound A Doppler ultrasound to check blood flow in your veins and to look for blood clots. Venogram can help confirm whether the patient has Varicose veins or another problem. VaricoseVeins : http://www.youtube.com/watch?v=GpjhgpFc8DY&list=PLFA1CFBF548099911

Varicose veins are diseased blood vessels that have become permanently dilated and can no longer efficiently carry blood back to the heart.  Arteries carry blood away from the heart while veins return blood back to the heart. Varicose veins can arise when this system gets backed up Varicose veins are dilated, elongated, and tortuous vessels that most commonly involve the superficial veins of the leg just under the skin What can be done to help prevent this? What are common reasons why people get these? Varicose veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs. However, they also can form in other parts of your body. Varicose veins are a common condition. They usually cause few signs or symptoms. In some cases, varicose veins may cause complications, such as mild to moderate pain, blood clots, or skin ulcers A number of factors may increase your risk for varicose veins. These include family history, age, gender, pregnancy, overweight or obesity, and lack of movement. (Standing for long periods) Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance. Family History Having family members who have varicose veins may raise your risk for the condition. About half of all people who have varicose veins have a family history of them. Age Getting older may put you at higher risk for varicose veins. The normal wear and tear of aging may cause the valves in your veins to weaken and not work as well. Gender Women tend to get varicose veins more often than men. Hormonal changes that occur during puberty, pregnancy, menopause, or with the use of birth control pills may raise a woman’s chances of getting varicose veins. Pregnancy During pregnancy, the growing fetus puts pressure on the veins in the legs. Varicose veins that occur during pregnancy usually get better within 3 to 12 months of delivery. Overweight or Obesity Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins. Lack of Movement Standing or sitting for a long time, especially with your legs bent or crossed, may raise your risk for varicose veins. This is because staying in one position for a long time may force your veins to work harder to pump blood to your heart.

Varicose Veins Multiple round and oval calcifications in soft tissues (phleboliths) represent calcified thrombi Shows the degree of collateral circulation Demonstrates patency of the deep venous system How Are Varicose Veins Diagnosed? Doctors often diagnose varicose veins based on a physical exam alone. Sometimes tests or procedures are done to find out the extent of the problem and to rule out other disorders.

Repair

Spider Veins Risk factors for spider veins are similar to those for varicose veins – age, heredity, pregnancy, hormonal changes, obesity and extended periods of standing – as well as sun exposure, particularly in fair-skinned people, and injuries to the skin surface. Some physicians believe that exercise, weight loss and the wearing of support hose and flat shoes instead of high heels can reduce the incidence of spider veins. Spider veins are a smaller version of varicose veins and a less serious type of telangiectasias. Spider veins involve the capillaries, the smallest blood vessels in the body. Spider veins often show up on the legs and face. They usually look like a spider web or tree branch and can be red or blue. They usually aren’t a medical concern. Spider veins, also known medically as telangiectasia or venulectasias, are the mildest manifestation of venous insufficiency, similar to varicose veins but smaller. They are small, often tangled groups of tiny blood vessels just under the skin surface that frequently resemble spider webs or tree branches Risk factors for spider veins are similar to those for varicose veins – age, heredity, pregnancy, hormonal changes, obesity and extended periods of standing – as well as sun exposure, particularly in fair-skinned people, and injuries to the skin surface. Some physicians believe that exercise, weight loss and the wearing of support hose and flat shoes instead of high heels can reduce the incidence of spider veins. Spider vein treatments are non-invasive or minimally invasive and include sclerotherapy and laser procedures They are considered cosmetic procedures

Phlebitis Inflammation of a vein Often associated with venous thrombosis US usually used to diagnose Treated with anticoagulants Phlebitis means inflammation in a vein. Commonly, phlebitis is accompanied by thrombus, or blood clot within the vein a.ka. thrombophlebitis. Patients with varicose veins, may have had phlebitis in the past and not realized it. Varicose Veins may thrombose, or clot and cause phlebitis. Patient may notice a red or pink discoloration in the skin overlying the inflamed vein. The area of phlebitis may be tender and feel warm to the touch. The vein with phlebitis may feel firm or rope like. Sometimes the clot within the vein harbors infection and there may be severe pain and high fever associated with the phlebitis. Acute phlebitis can be triggered by trauma or a prolonged period of sitting such as long airline or car travel. The blood that pools and stagnates in varicose veins puts abnormal pressure which contributes to phlebitis. Chronic, recurrent phlebitis may occur if the patient suffers from varicose veins and venous insufficiency.

Venogram – The Procedure LOWER LIMB VENOGRAMS Unilateral or Bilateral study LOWER LIMB VENOGRAMS Lower limb venography is common and is usually performed to rule out thrombosis of the deep veins of the leg. Venograms are usually obtained with contrast medium injected through a needle placed directly into a superficial vein in the foot.

Venogram - RT Leg Venous Study – The Procedure

Prior to Procedure Pt should fast or drink only clear fluids for four hours before the test - WHY Thorough PT history obtained Informed consent If pt is nervous about the doctor may give a sedative. fast or drink only clear fluids for four hours before the test. Get a history of allergies, hay fever, or bad reactions to an injected contrast Doctor may give you a sedative if the patient is very nervous

Explanation of Procedure: Legs The catheter is inserted into PT vein (usually a vein in the foot) Contrast is slowly injected. Tourniquet may be tied around the ankle of the foot the contrast is injected into - may also place one on the thigh The procedure takes about 30 - 45 minutes The catheter is inserted into the vein (usually a vein in the foot) and contrast is slowly injected. The tourniquet , which helps to fill the deep venous system with contrast. How Long Will It Take?  The procedure takes about 30 minutes for an uncomplicated venography. This time may increase, depending on the specifics of the procedure. The patient may need to keep the leg straight for six hours after the procedure has been completed.

Always label syringes!!! Contrast injected into top of foot Local anesthetic May be unilateral or bilateral Flush with saline mark syringe w/ band aid Syringes must be labeled between the contrast or saline – since both are clear 50 cc syringes may be used for contrast, 10 or 20 cc syringes for saline Saline is irritating and may burn when injected What is the purpose to flush with saline after the procedure? Always label syringes!!!

taken via fluoro and/or overheads films are taken Venogram Procedure The patient is asked to keep the leg still Radiologist may use fluoroscopy A series of images taken via fluoro and/or overheads films are taken fill the deep venous system with contrast The body may be tilted

Post contrast Imaging may be done with Fluoro and/or “overhead” images Begin imaging at the patient's ankle, and proceed superiorly to include the inferior vena cava as the injection continues. • Without fluoroscopy, usually obtain AP projections with the leg internally rotated 30 degrees to include the entire area of interest • Perform lateral projections if needed. • If imaging is performed with the patient supine, apply tourniquets just proximal to the ankle and knee to force filling of the deep veins in the leg. • Usually, expose serial radiographs 5 to 10 seconds apart. Injections may be made by hand, or an automatic injector may be set to deliver 1 or 2 mL/sec for a total of 50 to 100 mL.

FILMING VARIES WITH RADIOLOGIST MAY NEED SCOUT FILMS 14 X 17 Cassettes starting at Ankles, Knees, Femurs, Pelvis, Abdomen & Chest may also be taken What will the ABD film demonstrate? (Delay 15 Min – IVP Film) Overheads or 14x14 Fluoro Cassettes Or Digital Images taken With & Without Tourniquets

AP & LAT TAKEN

Contrast filling in the femoral veins leading to the IVC – Images may also be taken of the ABD (will look like a 15 min IVP image) And Chest - what anatomy will be seen filled with contrast in a Chest Image?

Atherosclerosis Left Leg Arterial Study How does this study compare to Venography? Plaque is primarily seen in the arteries due to the high pressure of blood volume from the heart. Veins can contain plaque – but more likely become thicken as describe with varicose veins. 44

CONSENTS SPECIAL PROCEDURES ARE INVASIVE SIGNED AND WITNESSED Refresher on Contrast Media SPECIAL PROCEDURES ARE INVASIVE ALWAYS GET PATIENT’S HISTORY AND CONSENT BEFORE BEGINNING OR GIVING ANY CONTRAST MEDIA Less money More reactions More money Less reactions CONSENTS SIGNED AND WITNESSED AFTER PROCEDURE HAS BEEN EXPLAINED CHECK DEPARTMENT PROTOCOL WHO’S RESPONSIBLE ??????

Contrast Media (non-ionic) Saline Xylocanine Peripheral venography may be performed with 30% or lower concentrations. The ionic agents of higher concentration and the nonionic agents are more viscous and produce greater resistance in the catheter during injection. Another alternative to iodinated contrast is the use of gadolinium. Gadolinium is primarily used as a contrast agent in magnetic resonance imaging (MRI) studies. However, it can be substituted for iodine contrast when the patient has a history of contrast reactions or compromised renal function. Gadolinium is less radiopaque than iodine; therefore narrow windows must be used in DSA imaging.

CONTRAST MEDIA CONTRAST INJECTABLE WATER SOLUABLE IONIC VS NON IONIC VENOUS INJECTON What should be checked before Drawing up the contrast? How many times should you check the label? Saline Strength Sterile Labeled Stings during injection

Aftercare Patients should drink large amounts of fluids to flush the remaining contrast solution from their bodies. The area around the incision will be sore for a few days. If there is swelling, redness, pain, or fever, the doctor should be notified. Pain medication may be needed. In most cases, the patient can resume normal activities the next day.

Risks & Complications phlebitis / infection at injection site tissue damage Formation of deep vein thrombosis in a healthy leg. A rare side effect in up to 8% of cases is a severe allergic reaction to the contrast. This usually happens within 30 minutes after injection

Possible Post Procedure Complications Congestive heart failure Acute renal insufficiency Venous thrombosis in a healthy leg Dislodging a clot, perhaps resulting in pulmonary embolus or other complications People with kidney problems or diabetes , especially those taking metformin (Glucophage), may have a higher risk for complications resulting from venography.

Abnormal results Abnormal venography results show well-defined filling defects in veins Findings include: Blood clots Consistent filling defects An abrupt end of a vessel Major deep veins that are unfilled Contrast flow that is diverted - These results confirm a diagnosis of deep vein thrombosis.

Venograms typically are done for the lower legs – Venous Circulation Venograms typically are done for the lower legs – Injection of contrast into the venous system can also be used for larger venous systems

Types of Other Venogram Procedures Leg (lower extremity) MOST COMMON Arm (upper extremity) Inferior Vena Cavagram Superior Vena Cavagram Adrenal Renal Saphenous Vein

Central Venography Central Venography Venous blood in veins flows proximally toward the heart. Injection into a central venous structure may not opacify the peripheral veins that anastomose to it. However, the position of peripheral veins can be indirectly documented by the filling defect from unopacified blood in the opacified central vein. The CIT observes the following guidelines: • Place the patient in the supine position for either a single-plane AP or PA projection or biplane projections. Move the patient's arms out of the field of view. • Obtain lateral projections at increased SID, if possible, to reduce magnification. • Remember that collimation to the long axis of the vena cava improves image quality but may prevent visualization of peripheral or collateral veins. (Frank, Eugene D.. Merrill's Atlas of Radiographic Positioning and Procedures, 11th Edition. Mosby, 022007. 25.3.5). <vbk:978-0-323-03317-6#outline(25.3.5)>

Catheter injection directly for upper leg

DVT of Iliac Vein On x-ray appears as a constant filling defect Largely replaced by duplex color doppler ultrasound Demonstrates the velocity of the venous blood flow Doppler is 95% accurate and is the preferred initial imaging modality. Demonstrates lack of compressibility of the vein and this indicates the presence of a thrombus.

Post Femoral Vein Puncture Orders Bed rest for 2-4 hours with affected leg straight. (Physician will specify) Check puncture site for sign of bleeding. Check B.P. q 1 hour x 4 hours. Encourage fluids. Resume pre-venography activity

Arteriogram – subclavian injection Upper Extremity Venogram – (valves present)

Review Anatomy of Upper Limb (RT 255 & 93

Inferior Vena Cavogram To view the inferior vena cava to determine strictures, tumor blockage and location of blood clots. A catheter is inserted in the femoral vein & positioned in the common iliac vein or the inferior aspect of the inferior vena cava. The contrast is injected through a multiple side hole catheter.

What is an IVC filter? An IVC Filter is a “wire basket” that is used to trap emboli. Several types available

Indications for IVC Filter Existing deep vein thromboses, history of pulmonary embolism. Surgical weight loss. Some cancer patients. When anticoagulation therapy is contraindicated. Prolonged bed rest/ immobility.

IVC Filter Placement Utilized to trap deadly Pulmonary Embolism’s Filter placed when anticoagulation therapy contraindicated. This Procedure SAVES Lives. RISKS – CAN PUNCTURE!

inferior vena cavogram Use of carbon dioxide (CO2) as a contrast medium is demonstrated (appearing white along the right of the spine) on a frail 75-year-old man. Patients who exhibit a history of severe reaction to iodinated contrast or with compromised renal function may undergo procedures in which CO2 is used as a contrast agent. CO2 is less radiopaque than blood and appears as a negative or void in angiographic imaging. CO2 is only approved for use below the diaphragm because the possibility of emboli is too great near the brain.

Inferior Vena Cava Filter Placement Designed to trap thrombus before causing an embolization When anticoagulants are contraindicated this can be used What is the contrast seen in the abd from?

Inferior Vena Cava Filter Placement

Superior VenaCavogram The contrast medium may be injected through a needle or an angiographic catheter introduced into a vein in an antecubital fossa, superior opacification results from injection through a catheter positioned in the axillary or subclavian vein. SUPERIOR VENACAVOGRAM Venography of the superior vena cava is performed primarily to rule out the existence of thrombus or the occlusion of the superior vena cava. The contrast medium may be injected through a needle or an angiographic catheter introduced into a vein in an antecubital fossa, although superior opacification results from injection through a catheter positioned in the axillary or subclavian vein. Radiographs should include the opacified subclavian vein, brachiocephalic vein, the superior vena cava, and the right atrium (Fig. 25-32). The injection program depends mostly on whether a needle, an angiographic catheter, or a regular catheter is used. A representative program for a catheter injection is 10 to 15 mL/sec for a 30- to 50-mL total volume of contrast medium. Images are produced in both planes, if desired, at a rate of one or two images per second for 5 to 10 seconds and are made at the end of suspended inspiration. contrast 30-50ml at 10-15ml/sec

Superior Venacavogram Primarily done to rule out thrombus or occlusion X-rays should include: Brachicephalic vein Subclavian vein Superior vena cava RT Atrium Stenosis on a Superior Venacavogram

Cerebral Venous system is visualized in Angio- How does the contrast exit the cranium? Angiography is helpful in assessing vascular abnormalities within the CNS, such as arteriosclerosis, arteriovenous malformations, aneurysms, subarachnoid hemorrhage, transient ischemic attacks, certain intracerebral hematomas, and cerebral venous thrombosis.

Post- Procedure Care- Apply pressure to puncture site 5-20 min. Patient monitored 6-8 hours in hospital. BEDREST. Watched for hematoma. Minimal activity for the 1st couple of days after discharge.

Hepatic Venogram Performed to rule out stenosis or thrombus of the hepatic veins Obtain pressure measurements of the veins inside the liver Usually catheter enters jugular vein or upper limb veins

Transjugular Intrahepatic Portosystemic Shunt Intervention for creating an artificial low-pressure pathway Between portal & hepatic veins Hepatic venogram usually preformed b before placement US also useful

Portal Venogram Portal System

Renal Venogram Rule out thrombosis of renal vein Renal vein catheterized to take blood Measure the production of renin Catheter insertion site: femoral vein Contrast injected 8ml/sec for 16ml total 2 images per second for 4 seconds

To view the renal veins for the presence of thrombosis. Renal Venogram: To view the renal veins for the presence of thrombosis. Can you distinguish the difference in the Procedures?

Leg Venography & Other Modalities It is nearly 100% sensitive and specific in making this diagnosis (pulmonary embolism is diagnosed in other ways).= HOW? Accuracy is crucial since deep vein thrombosis can lead to pulmonary embolism, a condition that can be fatal. It is especially useful when there is a strong suspicion of deep vein thrombosis, but non-invasive tests (ultrasound) have failed to identify the disease. Doppler U.S. used to determine presence of DVT. MRI & CT can also be used. Fluoroscopy in the Angio suite used for insertion of filters for IVC.

Venography is not used often, because it is painful & expensive Venography takes between 30-45 minutes + up to 10 min of beam on – fluoro time May be done in a physician's office, or a hospital. US – Now modality of choice Unless results are inconclusive

Peripheral Vascular Ultrasound Upper/Lower Arterial Evaluation PROCEDURES DONE w/ US Peripheral Vascular Ultrasound Upper/Lower Arterial Evaluation Upper/Lower Venous Evaluation Carotid Ultrasound Renal Duplex Imaging Because venography is an invasive technique, other modalities have been developed for detecting DVT. Duplex color Doppler ultrasound, which demonstrates changes in the velocity of venous blood flow with 95% accuracy, is now the preferred initial imaging modality

VASCULAR ULTRASOUND non-invasive - no contrast no radiation

BENEFITS RISKS THE END of Venogram Lecture try the Review questions…… Less Expensive ? Non Invasive/Painless (If No Health Problems) Soft Tissue Visualized Tortuous Veins Well Visualized Has Replaced Venography Capable Of Replacing Angio Someday (?) Sometimes Inconclusive or Unclear Vein Is Totally Closed Off Or Not? Unable To See Deep Vessels THE END of Venogram Lecture try the Review questions……

Venous thrombosis most often affects the: Deep veins of the upper extremities Deep veins of the lower extremities Superficial veins of the upper extremities Superficial veins of the lower extremities

Which term refers to an inability of the heart to propel blood at a sufficient rate and volume? Congestive heart failure Pulmonary edema Valvular disease Valvular stenosis

The invasive procedure for determining deep vein thrombosis is: Doppler ultrasound Venography CT Arteriography

What is a life threatening pathology that can occur from a dislodged thrombus? Deep venous thrombosis Atherosclerosis Pulmonary edema Pulmonary embolism

Which of the following are symptoms or PE? Cough Fever Chest pain A) 1 & 2 B) 1 & 3 C) 2 & 3 D) All the above

What is the purpose of a IVC filter? To decrease blood flow to diseased liver B)To graft a blocked artery in the pulmonary artery C) To prevent thrombus from migrating to heart

With varicose veins, the valves are working harder to keep a constant flow of blood to the heart. True False