Doppler ultrasound of normal venous flow

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Doppler ultrasound of normal venous flow

  1. 1. Doppler ultrasound of normal venous flow Samir Haffar M.D.
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. Phasicity Flow changes with respiration Slow ApneaRapid
  6. 6. 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
  7. 7. Compressibility of veins Do not press too hard since the normal vein collapses very easily making it difficult to find
  8. 8. External compression of the veins CompressionRelaxation
  9. 9. Incompressibility = Thrombus Do not compress vein more than necessary in acute thrombus Fear of detaching thrombus to cause PE Myers KA & Clough A. Making sense of vascular ultrasound. Arnold, London, 2004.
  10. 10. Transverse compression of veins Normal vein Complete collapse Nonocclusive thrombosed vein Partial collapse Completely thrombosed vein No collapse Hamper UM et al. Radiol Clin N Am 2007 ; 45 : 525 – 547.
  11. 11. 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
  12. 12. Augmented flow in popliteal vein Aug Valve closed Competent vein
  13. 13. 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
  14. 14. Valsalva’s maneuver A V At rest A V Valsalva
  15. 15. Valsalva’s maneuver End Valsalva Start Valsalva Competent vein
  16. 16. Venous valve Two cups of a valve clearly seen It is uncommon to see venous valves with this clarity Stasis of blood evident behind one of the valve cups
  17. 17. Venous reflux Significant venous reflux of > 2 sec duration Augmentation or Valsalva
  18. 18. 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.
  19. 19. Venous stasis Echogenic speckle pattern of a deep calf vein Movement of blood is visible in real time Echogenic Blood
  20. 20. Thank You

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