1. US review March 9, 2011

2. Rule out DVT

3. If the vein completely compresses there is no underlying clot.

4. no clot
clot

5. Linear Array Probe (5-10 mHz)

6. Patient reclines at 45o
Hip externally rotated

7. Note: SFV – “superficial” femoral vein is a deep vein!

9. Just 2 key areas to compress

10. Our protocol: 4 compression clips
CF-saph
bifurcation
pop
“trifurcation”

11. A normal exam:

12. Clip #1
CF-saph

13. CFV – G. Saphenous Junction

14. Clip #2
bifurcation

15. Bifurcation: SFV and DFV

16. Clip #3
pop

17. Pop V

18. Clip #4
“trifurcation”

19. “trifurcation”: pop divides

20. Some clots:

21. DVT in CFV

22. Clip: partially occlusive DVT

24. movie: mobile DVT

25. movie: DVT in CFV

26. Movie: DVT in pop

27. Chronic DVTs look different

28. Chronic DVT
shrunken
fibrotic (hyperechoic)
collaterals
recanalized

29. clip: lymph node

30. The exam is simple!

31. Stuff you don’t have to know:

32. You can skip:
the mid-thigh
the calf
Doppler

33. mid-thigh: SFV

34. Calf veins: OK to skip

35. Calf DVTs - Unreliable to diagnose: < 70% sensitivity
- Unclear significance: 75% resolve without treatment

36. But what if you find a calf DVT?
Plan A: anticoagulate
Plan B: ASA only. Monitor for extension
(Not all calf veins are equally important)

37. Clip: calf veins

38. Is Doppler needed? No. Compression is sufficient.
Color can sometimes help identify vessels.
Doppler can give false normals:
eg non-occlusive DVT has normal augmentation.

39. Doppler flow info: Augmentation:
- squeeze the calf and blood rushes past the probe
- implies no obstruction between calf and probe
Respiratory phasicity:
- flow stops on inhale, goes on exhale
- implies no obstruction up in pelvis

40. Venous flow
(note respirations)

41. phasic flow and augmentation

42. What is “duplex”?
2 modalities together:
U/S + Doppler

43. Quiz!

44. A C B

45. A C D B

46. A B

47. Where on the leg are we?

48. The End