This document discusses duplex assessment of venous hemodynamics. It describes how duplex ultrasound can be used to assess venous hemodynamic changes through maneuvers like Valsalva and Parana. This allows for evaluation of valve competence and incompetence, as well as identifying different hemodynamic configurations like closed and open shunts. Understanding venous hemodynamics through duplex assessment is important for accurate diagnosis and treatment of venous disease.
Who Needs More Testing Beyond Venous Duplex?Vein Global
By: William Marston, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Who Needs More Testing Beyond Venous Duplex?Vein Global
By: William Marston, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
By: Joseph Zygmunt, Jr., RVT, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
By: Joseph Zygmunt, Jr., RVT, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Does All Saphenous Reflux Need Ablation?Vein Global
By: Paul M. McNeill, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Role of medical imaging in management of arteriovenous fistula Dr. Muhammad B...Dr. Muhammad Bin Zulfiqar
This presentation is very helpful for vascular sergeons, interventional radiologists and sonographers that how to map Vasculature before construction of AV fistula for hemodialysis, how to check its patency, how to check its proper functioning ,to comment on its failure and decide when to reintervene.
Paradigms have been shifting.
Flow-centered ideas, ventriculo-arterial coupling and redistributions between compartments with different time constants.
central venous pressure and intra-arterial blood pressure monitoring. invasiv...prateek gupta
central venous pressure and intra-arterial blood pressure monitoring. various sites for cvp and Ibp insertion. working principle for cvp and ibp. indication and complication. various waveform of cvp and ibp
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
Slide 1: Title Slide
Extrachromosomal Inheritance
Slide 2: Introduction to Extrachromosomal Inheritance
Definition: Extrachromosomal inheritance refers to the transmission of genetic material that is not found within the nucleus.
Key Components: Involves genes located in mitochondria, chloroplasts, and plasmids.
Slide 3: Mitochondrial Inheritance
Mitochondria: Organelles responsible for energy production.
Mitochondrial DNA (mtDNA): Circular DNA molecule found in mitochondria.
Inheritance Pattern: Maternally inherited, meaning it is passed from mothers to all their offspring.
Diseases: Examples include Leber’s hereditary optic neuropathy (LHON) and mitochondrial myopathy.
Slide 4: Chloroplast Inheritance
Chloroplasts: Organelles responsible for photosynthesis in plants.
Chloroplast DNA (cpDNA): Circular DNA molecule found in chloroplasts.
Inheritance Pattern: Often maternally inherited in most plants, but can vary in some species.
Examples: Variegation in plants, where leaf color patterns are determined by chloroplast DNA.
Slide 5: Plasmid Inheritance
Plasmids: Small, circular DNA molecules found in bacteria and some eukaryotes.
Features: Can carry antibiotic resistance genes and can be transferred between cells through processes like conjugation.
Significance: Important in biotechnology for gene cloning and genetic engineering.
Slide 6: Mechanisms of Extrachromosomal Inheritance
Non-Mendelian Patterns: Do not follow Mendel’s laws of inheritance.
Cytoplasmic Segregation: During cell division, organelles like mitochondria and chloroplasts are randomly distributed to daughter cells.
Heteroplasmy: Presence of more than one type of organellar genome within a cell, leading to variation in expression.
Slide 7: Examples of Extrachromosomal Inheritance
Four O’clock Plant (Mirabilis jalapa): Shows variegated leaves due to different cpDNA in leaf cells.
Petite Mutants in Yeast: Result from mutations in mitochondrial DNA affecting respiration.
Slide 8: Importance of Extrachromosomal Inheritance
Evolution: Provides insight into the evolution of eukaryotic cells.
Medicine: Understanding mitochondrial inheritance helps in diagnosing and treating mitochondrial diseases.
Agriculture: Chloroplast inheritance can be used in plant breeding and genetic modification.
Slide 9: Recent Research and Advances
Gene Editing: Techniques like CRISPR-Cas9 are being used to edit mitochondrial and chloroplast DNA.
Therapies: Development of mitochondrial replacement therapy (MRT) for preventing mitochondrial diseases.
Slide 10: Conclusion
Summary: Extrachromosomal inheritance involves the transmission of genetic material outside the nucleus and plays a crucial role in genetics, medicine, and biotechnology.
Future Directions: Continued research and technological advancements hold promise for new treatments and applications.
Slide 11: Questions and Discussion
Invite Audience: Open the floor for any questions or further discussion on the topic.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
Duplex assessment of venous hemodynamics 3 oct 13th, 2011, morning 20mn2
1. Duplex Assessment
of Venous
Hemodynamics
Claude FRANCESCHI, Roberto DELFRATE
Paris France, Cremona Italy
2. Hemodynamics knowledge is the
backbone of nowadays
performance in Diagnosis and
Treatment of Arterial and Cardiac
disease
Hemodynamics ignorance is the
reason for the still raw diagnosis
and treatment of the Venous
Disease despite the advanced
technologies that cannot
compensate theoretical lacks
3. Venous Hemodynamics
knowledge demands a peculiar
intellectual effort because:
Not teached in most universities
Weakly promoted ( known?) by
the majority of Phlebology
Opinion Leaders and Scientific
Societies
More complex than arterial
4. Duplex assessment of
venous
hemodynamics is the
key point for a better
diagnosis and
appropriate treatment
strategy
IF lighted by rational
and coherent
theoretical models
5. Duplex aims at
assessing the
hemodynamic
changes of the
venous system
According to the
various
hemodynamic
configurations
6. Pressure and Flow Overloading is
responsible for TMP EXCESS
TMP Excess is Responsible for
-Veins Dilatation ( Varicose)
-Drainage impairment ( trophic changes :
edema, hypodermitis, ulcer…)
7. Pressure and Flow Overloading is due
to
Venous Block responsible for
-Permanent Venous Pressure Excess
-Compensatory collaterals (Open Shunts)
Valve Incompetence responsible for
-Deep Reflux ( various grades)
-Superficial Reflux
- -Closed Circuits ( Closed Shunts)
- -Deviated Flows ( Open deviated Shunts)
8. DUPLEX is able to assess all these
complex configurations made of
blocks and shunts
IF performed according to appropriate
data assessments
So providing accurate diagnosis and
consequently appropriate treatment
13. Valsalva Manoeuvre:
Increases the Toraco-abdominal venous
pressure
and reverses downwards the pressure
gradient but not the flow when blocked by
the valves closure
14. Valsalva Manoeuvre:
Valsalva is negative when the valves are
Competent
Flow is blocked by blowing ( systole)
and appears at release (diastole)
At
rest
Systole
=
blowing
Relax
Diastole
15. Valsalva Manoeuvre:
Valsalva is Positive when valves are
Incompetent Valve
Reverse Flow appears when blowing
( systole) and at release (diastole)
At
rest
Systole
=
blowing
Relax
Diastole
16. Exception!!!!!
Contrary to the majority of the veins,
AT DESCENDING TRIBUTARIES OF THE
SAPHENA ARCH
Positive Valsalva flow fed by pelvic leaks
doesn’t reverse direction
o P
c P
p P
s g P
ig P
i P i P
o P
c P
p P
gs P
g s P
At
rest
Systole
=
blowing
Relax
Diastole
17. Hemodynamic Manoeuvres
Upright Position
Valsalva: Thoraco-abdominal
Pump Stress Test
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump Stress Test
Supine Position
Venous Pressure: Hemodynamic
obstacles assessment
29. Deep CLOSED SHUNT
Diastolic Reflux overloaded by a competent
collateral vein flow
At
rest
Femoral Example
Femoral Example
Diastolic
Reflux Peak
and volume
Higher than
Systolic
30. Superficial CLOSED SHUNT
Superficial Diastolic Reflux overloaded by a deep
vein flow
At
rest
Great Saphena Example
Great Saphena Example
Diastolic
Reflux Peak
and volume
Higher than
Systolic
S
D
31. Superficial CLOSED SHUNT
Superficial Diastolic Reflux overloaded by a deep
vein flow
At
rest
Great Saphena Example
Great Saphena Example SHUNT 1
Diastolic
Reflux Peak
and volume
Higher than
Systolic
S
D
Positive (+)
Valsalva
32. Superficial CLOSED SHUNT
Superficial Diastolic Reflux overloaded by a deep
vein flow
Other Closed Shunts have the same
hemodynamic features but are different
according to the deep leak point that
feed them their and the re-entry point
that drain them and the involved
network
33. i P i P
o P
c P
p P
s g P
ig P
o P
c P
p P
gs P
g s P
Sapheno-femoral Junction
Sapheno-popliteal Junction
Pelvis leak points
Various Perforators
Networks:
N1, N2, N3, N4
35. Superficial OPEN DEVIATED SHUNT
Superficial Diastolic Reflux overloaded by a
deep
other vein flow
superficial collateral veins flow
At
rest
Great Saphena Example
Great Saphena Tributary Example
Diastolic
Reflux Peak
and volume
Higher than
Systolic
S
D
Negative (-)
Valsalva
37. Superficial OPEN VICARIOUS SHUNT
Superficial Systolic Diastolic flow Reflux overloaded overloaded by by deep
a deep
vein flow
Great Saphena Example
At
rest
Great Saphena By-Passing a popliteal
Rest, Systolic
Peak and
Diastolic
antegrade
flow
S
block Example
venous flow
D
38. o P
c P
p P
s g P
ig P
i P i P
o P
c P
p P
gs P
g s P
Networks and their Connections are
checked up :
Flow direction and modulation
- -at rest
- under hemodynamic stress
manoeuvres
Selected according to the peculiar status of
each patient
In order to depict a taylored topo-hemodynamic
feature
39. Hemodynamic Manoeuvres
Upright Position
Valsalva: Thoraco-abdominal
Pump Stress Test
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump Stress Test
Supine Position
Venous Pressure: Hemodynamic
obstacles assessment
40. Venous Pressure Measurement:
Veins Patency Test
Supine Position
Normal ≤ 25 mm Hg
Cuff
inflation/deflation
Posterior Tibial Vein
flow
48. Venous Networks ( N )
1988
Draining Veins
N1
N2
N3
Deep veins
TRUNKS
Ant.Saph.
Great saph.
GiacominiV.
Small saph.
Saph. and Extra
Saph. tributaries
53. Venous Networks ( N )
N3 ►N1 perforators
Pelvis
6 perforators
Perineal V P Point
Rd Ligt V I Point
Clit. V C Point
Obt. V O Point
I Glut.V IG Point
S Glut. V SG Point
o P
c P
p P
s g P
ig P
i P i P
o P
c P
p P
gs P
g s P
Franceschi C, Bahnini A. (2005) Treatment of
lower extremity venous insufficiency due to pelvic
leaks points in women; Ann vasc Surg; 19; 284-88
54. Networks and their Connections
are checked up :
Flow direction and modulation
- at rest
- under hemodynamic
stress manoeuvres
Selected according to the
peculiar status of each patient
In order to depict a taylored
topo-hemodynamic feature
55. Duplex assessment of
venous
hemodynamics
Lower limbs
Venous Networks (N)
Dynamic Stress Manoeuvres
Hemodynamic Obstacles and Open
Vicarious Shunts
Hemodynamic Valve Incompetence
and Closed/Open Derivate Shunts
Protocole Assessment
Hemodynamic Mapping
56. Hemodynamic Manoeuvres
Upright Position
Valsalva: Thoraco-abdominal
Pump Stress Test
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump Stress Test
Supine Position
Venous Pressure: Hemodynamic
obstacles
57. Hemodynamic Manoeuvres
Upright Position
Valsalva: Thoraco-abdominal
Pump Stress Test
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump Stress Test
Supine Position
Venous Pressure: Veins Patency
Test
59. Valsalva Manoeuvre:
Systolic Block of Thoraco-abdominal Pump
increases the Toraco-abdominal venous
pressure
So reversing downwards the pressure
gradient without flow reversal thanks to the
peripheral valves closure
60. Valsalva Manoeuvre:
Toraco-abdominal Pump Systolic Block
increases the Toraco-abdominal venous
pressure
So reversing downwards the pressure
gradient it produces a reversal reflux flow
when the peripheral valves are incompetent
61. Valsalva Manoeuvre:
How to achieve Valsalva Manoeuvre
easily and effectively :
Blowing into a KNOTTED STRAW
Blow!
63. Valsalva Manoeuvre:
Negative Valsalva = Competent Valve
VALVE COMPETENCE = NO SYSTOLIC REFLUX
At rest, Permenant and Slow Upwards
flow due to Residual Pressure
At
rest
64. Valsalva Manoeuvre:
Negative Valsalva = Competent Valve
VALVE COMPETENCE = NO SYSTOLIC REFLUX
then the flow is blocked by the Valsalva
At
rest
systole
Systole
=
blowing
65. Valsalva Manoeuvre:
Negative Valsalva = Competent Valve
then the flow is blocked by the Valsalva
At
rest
systole
Systole
=
blowing
66. Valsalva Manoeuvre:
Negative Valsalva = Competent Valve
VALVE COMPETENCE = NO SYSTOLIC REFLUX
Then at release, le blood flows upwards
again thanks to the thoraco-abdominal
At
rest
pump diastole
Systole
=
blowing
Relax
Diastole
70. Valsalva Manoeuvre:
Positive Valsalva = Incompetent Valve
VALVE INCOMPETENCE = ONLY SYSTOLIC REFLUX
Normal at Diastole
At
rest
Systole
=
blowing
Relax
Diastole
71. Valsalva Manoeuvre:
Positive Valsalva = Incompetent Valve
VALVE INCOMPETENCE = ONLY SYSTOLIC REFLUX
Normal at Diasole
At
rest
Systole
=
blowing
Relax
Diastole
72. Valsalva Manoeuvre:
Contrary to the majority of the veins,
DESCENDING TRIBUTARIES OF THE
SAPHENE ARCHS flow
downwards
and its refluxes are not reverse flows
SO Valsalva is Positive when it
produces a no reverse systolic
downwards flow
The reflux is fed by one of the pelvic
leak points
o P
c P
p P
s g P
ig P
i P i P
o P
c P
p P
gs P
g s P
73. At
rest
Valsalva Manoeuvre:
Contrary to the majority of the veins,
DESCENDING TRIBUTARIES OF THE
SAPHENE ARCHS flow
downwards
and are not reverse flows nor reflux when
at rest
74. Contrary to the majority of the veins,
DESCENDING TRIBUTARIES OF THE
and are not reverse flows nor reflux at rest .
The absence of reflux is attested by absence of
flow during the Systole
At
rest
Valsalva Manoeuvre:
SAPHENE ARCHS flow
downwards
Systole
=
blowing
75. Contrary to the majority of the veins,
DESCENDING TRIBUTARIES OF THE
and are not reverse flows nor reflux when
at rest and during the diastole
At
rest
Valsalva Manoeuvre:
SAPHENE ARCHS flow
downwards
Systole
=
blowing
Relax
Diastole
76. Valsalva Manoeuvre:
DESCENDING TRIBUTARIES OF THE
SAPHENE ARCHS
PositiveValsalva = Systolic Downwards flow
WITHOUT REVERSE FLOW
REFLUX FROM INCOMPETENT PELVIC PERFORATORS
77. At
rest
Valsalva Manoeuvre:
DESCENDING TRIBUTARIES OF THE
SAPHENE ARCHS
PositiveValsalva = Systolic Downwards flow
WITHOUT REVERSE FLOW
78. DESCENDING TRIBUTARIES OF THE
PositiveValsalva = Systolic Downwards flow
WITHOUT REVERSE FLOW
At
rest
Valsalva Manoeuvre:
SAPHENE ARCHS
Systolic
REFLUX
=
blowing
REFLUX FROM
INCOMPETENT PELVIC
PERFORATORS
79. At
rest
Valsalva Manoeuvre:
DESCENDING TRIBUTARIES OF THE
SAPHENE ARCHS
PositiveValsalva = Systolic Downwards flow
WITHOUT REVERSE FLOW
Relax
Diastole
Systolic
REFLUX
=
blowing
81. Hemodynamic Manoeuvres
Upright Position
Valsalva: Thoraco-abdominal
Pump Stress Test
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump Stress Test
Supine Position
Venous Pressure: Veins Patency
Test
84. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Squizing:
Not physiologic
Passive Systole of the VMP
+
N2 and N3 emptying
85. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Paranà:
Physiologic
Active Systole of the VMP and
plantar pump
BY
Proprioceptive reflex contraction
triggerd by a light push-pull at the
waist
91. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
At rest, very low upwards flow
At
rest
92. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Pull 2 cms back but quickly
In order to trigger a Systole by
Proprioceptive reflex contraction of
the calf
At
rest
93. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Then Push ahead 2 cms but quickly
In order to relax the
Proprioceptive reflex contraction of
the calf (Diastole)
At
rest
95. At
rest
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Ilio-femoro-popliteal TOTAL incompetence
Popliteal Vein
At rest
96. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Ilio-femoro-popliteal TOTAL incompetence
Systole
At
rest
Popliteal Vein
97. At
rest
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Ilio-femoro-popliteal TOTAL incompetence
Popliteal Vein
Diastole
S
coequal
D
98. At
rest
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
SEGMENTAL Popliteal Incompetence
Popliteal Vein
At rest
99. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
SEGMENTAL Popliteal Incompetence
Systole
At
rest
Popliteal Vein
100. At
rest
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
SEGMENTAL Popliteal Incompetence
Popliteal Vein
Diastole
S
D peak
D
<
S peak
Femoral Valve
Closure
Decreases the
Reflux
101. At
rest
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
PARTIAL Popliteal Incompetence
Popliteal Vein
At rest
102. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
PARTIAL Popliteal Incompetence
Systole
At
rest
Popliteal Vein
103. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
At
rest
PARTIAL Popliteal Incompetence
Popliteal Vein
Diastole
S
D
D peak
<
S peak
D time
>
S time
104. At
rest
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Deep Closed Shunt Example
Incompetent Fem-Popliteal V
+ Competent Collat.V ( may be Deep Fem.)
Popliteal Vein
Diastole
D peak
>
S peak
105. At
rest
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Ilio-femoro-popliteal TOTAL incompetence
Great Saphenous vein
At rest
106. Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Ilio-femoro-popliteal TOTAL incompetence
Systole
At
rest
Popliteal Vein
107. At
rest
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump VMP Stress
Test
Ilio-femoro-popliteal TOTAL incompetence
Popliteal Vein
Diastole
S
coequal
D
108. Hemodynamic Manoeuvres
Upright Position
Valsalva: Thoraco-abdominal
Pump Stress Test
Squizing, Paranà , Wundsdorf:
Valvo-muscular Pump Stress Test
Supine Position
Venous Pressure: Veins Patency
Test
109. Venous Pressure Measurement:
Veins Patency Test
Supine Position
Normal ≤ 25 mm Hg
Cuff
inflation/deflation
Posterior Tibial Vein
flow
110. Duplex assessment of
venous
hemodynamics
Lower limbs
Venous Networks (N)
Dynamic Stress Manoeuvres
Hemodynamic Obstacles and Open
Vicarious Shunts
Hemodynamic Valve Incompetence
and Closed/Open Derivate Shunts
Protocole Assessment
Hemodynamic Mapping
111. Hemodynamic Obstacles
The hemodynamic significance of a
block in terms of drainage quality is
inversely proportional to the collateral
compensatory veins developing
112. N1
N2
N3
N4L
N4T
Collectors:
N2 -N1: SFJ, SPJ
N3 -N1: Perineal V P Point
Rd Ligt V I Point
Clit. V C Point
Obt. V O Point
I Glut.V IG Point
S Glut. V SG Point
Internetworks connections
Perforators:
N2 -N1: saphenous truncks→deep Veins
N3 -N1:Saphenous tributaries and
others→deep Veins
Connectors:
N2 –N2: saphenous truncks
N3 -N1:Saphenous tributaries and others
113. N1
N2
N3
N4L
N4T
Collectors:
N2 -N1: SFJ, SPJ
N3 -N1: Perineal V P Point
Rd Ligt V I Point
Clit. V C Point
Obt. V O Point
I Glut.V IG Point
S Glut. V SG Point
Internetworks connections
Perforators:
N2 -N1: saphenous truncks→deep Veins
N3 -N1:Saphenous tributaries and
others→deep Veins
Connectors:
N2 –N2: saphenous truncks
N3 -N1:Saphenous tributaries and others
114. Draining network from skin to suprafascial veins (Network 3) then intrafascial veins
(Network 2) then deep subfascial veins (Network 1)
Common Femoral Vein
Great Saphenous Arch
Anterior Saphena
Deep Femoral Vein
Great Saphenous Trunk
Superficial Femoral Vein
Giacomini Vein
Small Sahenous Arch
Popliteal Vein
Small Sahenous Trunk
N2
N3
N4L
N4T
1988
N1
115.
116. Dynamic manoeuvres
Valsalva manoeuvres
Active calf pump test
Passive calf pump test
Networks N1,N2,N3,N4
Obstacle assessments
Dynamic Obstacle assessments
Demodulatlion
collateral by-pass
doppler ankle pressure
Anatomic Obstacle assessments
Color
Compression
117. Assessment protocole
Mapping
Strategies
Tactics
Valve competence
assessment
Valve incompetence
assessment : value
SHUNTS: venous segment
overloaded by extra
volume/pressure fed by Escape
points and redirected into Re-entry
points :
Sapheno-femoral junction
Sapheno-Popliteal junction
Pelvic leak points
Perforators
Open vicarious shunts
Open derivating shunts
Closed shunts
superficial : type
1 to 6
deep
Mixt shunts
118. N1
N2
N3
N4L
N4T
Collectors:
N2 -N1: SFJ, SPJ
N3 -N1: Perineal V P Point
Rd Ligt V I Point
Clit. V C Point
Obt. V O Point
I Glut.V IG Point
S Glut. V SG Point
Internetworks connections
Perforators:
N2 -N1: saphenous truncks→deep Veins
N3 -N1:Saphenous tributaries and
others→deep Veins
Connectors:
N2 –N2: saphenous truncks
N3 -N1:Saphenous tributaries and others