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Vein mapping

Vein mapping






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    Vein mapping Vein mapping Presentation Transcript

    • Vein Mapping At re*be How and why we do it.
    • Purpose • Vein Mapping is done on people with more serious vein problems. • It is done to identify the anatomy and the physiology of a problem in the venous system. • It is most critically important to plan the EVLA procedure. • It is a significant document for the insurance companies so we can get paid. $$$$$
    • The Vein Map Form Name: Date: Dr. Ronald J. Kolegraff M.D. The re*be Vein Clinic P.O. Box 125 1008 East View Ave Unit 8 Okoboji, Iowa 51355 www.rebeyou.com (712) 332-6001 (712) 332-6010 fax Right Left Socks _______ _______ _______ _______Left Socks _______ _______ _______ _______Right Deep Veins Compress Flow Clot Yes No Img Yes No Img Yes No Img CFV FV POP Notes: GSV = Greater Saphenous Vein AAGSV = Anterior Accessory GSV PAGSV = Posterior Accessory GSV SAGSV = Superficial Accessory GSV PTCV = Posterior Thigh Circumflex Vein ATCV = Anterior Thigh Circumflex Vein SSV = Small Saphenous Vein CESSV = Cranial Extension of the SSV CFV = Common Femoral Vein FV = Femoral Vein PFV = Profunda Femorus Vein POP = Popliteal Vein ⊥ = Tributary away from Dr T = Tributary toward Dr < = Valve O = Perforator A = Access Point
    • The Form is going to change • As we learn more and need to record more and our documentation, ultrasound, and planning skills improve, this form will change. • Fill it out with pencil for now. We may need to make changes later to the map.
    • Acceptable Names for Veins • The names of veins is not stable. • Many clinics use different names than we do. • We do it right • These are the vein names we will use. • Others may be added as the form changes.
    • Some naming rules • Accessory veins start on and then rejoin the vein they are named after. - The anterior accessory GSV leaves the Greater Saphenous Vein and then travels anterior to it rejoining it somewhere else. • A tributary is a branch we don’t know where it goes yet or it just ends in very small ‘normal’ veins.
    • More Rules • A perforator dives deep into the leg. – These are good things usually. – They connect the superficial system with the deep system. – They can become diseased and reflux. – If they do treatment can be indicated. • A valve is marked when they are located. – Broken valves are usually the reason reflux occurs. • Access points are marked to plan where to get into a vein during the EVLA procedure.
    • The legend for the mapping Symbols • Symbols • These go in the symbol box. There are 4 of these boxes on the form.
    • There are two types of Vein Maps • The anatomic map – This just a drawing where the veins are and where they branch from their major source veins. • The hemodynamic map – This is a drawing showing flow of blood. – Only the abnormal areas are marked – It goes on top of the anatomic map like an overlay.
    • The Mapping Process • Deep System Exam – Checking for clots with compression and flow studies • Superficial Venous Exam – Creating a road map and checking for reflux
    • The Deep Venous system • These veins need to be present and working properly as they will take the blood flow if and when the superficial system is treated with EVLA or Sclerotherapy.
    • Veins of the Deep System are Checked For • Compression • Flow • Clot
    • Compression • The Ultrasound probe is pushed against the skin watching the vein walls. • If compression is normal the vessel will close and not be very visible at all on the ultrasound screen • Letting up the compression allows the vein to fill again.
    • Flow • Color Doppler Ultrasound allows flow to be checked. • Red means flow away from the heart. • Blue means flow toward the heart.
    • Clot • If there is a clot in a vein it will not compress completely. • There will not be any flow in the area of the clot. • Flow can occur around the clot.
    • Evaluation Points • Common Femoral Vein • Femoral Vein • Popliteal Vein • Smaller calf veins
    • Documentation
    • Check the boxes • Img refers to an image being saved on the ultrasound for this exam.
    • Superficial Venous Exam • Fast Survey the GSV (or the SSV) – Using the ultrasound move from ankle to Groin to be sure there are no surprises (like someone took the vein out) – No map marks at this point. • Slow survey this time place pencil cross marks on the vein drawing where something is found. – Fill the symbol box with the appropriate symbol.
    • Mapping Process Continued • Map the tributaries. – Follow them from the vein they branch from and see where they go. – This completes the anatomic map • Do the hemodynamic flow studies to see what refluxes and where on the map the reflux occurs. – Mark the anatomic map with the reflux symbols to show which areas are diseased. – (we do not yet have a symbol to mark the reflux)