Lower Extremity Venous Protocol
Scan through and verify patent venous system before augmenting
Structure
External Iliac Vein
Common Femoral &
Great Saphenous Vein
Junction
Femoral Vein Central
& Deep Femoral Vein
(aka Profunda
Femoris Vein)
Femoral Vein Mid
Femoral Vein
Peripheral
*Hunter’s Canal
Popliteal Vein
Posterior Tibial Veins
Peroneal Veins
Scan Plane
Transverse
Dual Screen
Sagittal
Transverse
Dual Screen
Sagittal
Transverse
Dual Screen
Sagittal
Transverse
Dual Screen
Sagittal
Transverse
Dual Screen
Sagittal
Transverse
Dual Screen
Sagittal
Transverse
Dual Screen
Sagittal
Transverse
Dual Screen
Sagittal
Label
Identify RT or LT
EIV
W/COMP
EIV
EIV W/AUG
CFV/GSV
W/COMP
CFV/GSV
CFV W/AUG
GSV W/AUG
FV CENTRAL/DFV
W/COMP
FV CENTRAL/DFV
FV W/AUG
DFV W/AUG
FV MID
W/COMP
FV MID
FV MID W/AUG
FV PERIPH
W/COMP
FV PERIPH
FV PERIPH W/AUG
POP V
W/COMP
POP V
POP V W/AUG
PTV
W/COMP
PTV
PTV W/AUG
PERONEAL V
W/COMP
PERONEAL V
PERONEAL V W/AUG
Images Stored
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with augmentation
Gray Scale CFV & GSV- without compression
Gray Scale CFV & GSV-with compression
Color Doppler CFV & GSV
CFV-Color & Spectral Doppler with augmentation
GSV-Color & Spectral Doppler with
augmentation
Gray Scale FV Central & DFV- without
compression
Gray Scale FV Central & DFV-with compression
Color Doppler FV Central & DFV
FV Central-Color & Spectral Doppler with
augmentation
DFV-Color & Spectral Doppler with augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with augmentation
Anatomy/Image Correlation
Artery
Vein
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Artery
Vein with
Compression
Vein with Spectral Doppler
Lower Extremity Venous Protocol
Tips
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When referring to the venous system, the term central means closer to the heart (proximal on the leg),
and the term peripheral means farther from the heart (more distal on the leg)
Deep veins always accompany an artery
You should scan the entire leg from groin to ankle in transverse with compression before storing images.
 Only compress veins in the transverse view
 Augmentation should not be performed distal to a thrombus/ non-compressible vein
Always scan the symptomatic area (area of pain or palpable mass) in addition to LEV protocol
Color and Spectral Doppler
 Veins should fill completely with color - angle or square box, or use power Doppler if needed
 No angle correct is needed
 Gate should be placed in center of vessel
 Spectral waveforms should be phasic and augment with distal compression
 If proximal (more central) obstruction is suspected, evaluate the contralateral EIV or CFV for symmetry
of spectral waveforms
Thrombus Present
 Do not augment peripheral to the location of the thrombus
 Document thrombus with color & spectral Doppler
 Document exact location of thrombus
 Determine if thrombus is occlusive or non-occlusive
Other Pathology Present
 Enlarged lymph nodes, fluid collections, or any other masses should be documented and measured in
sagittal and transverse planes, and with color Doppler (spectral if indicated)
 Edema should be documented in gray scale
 Incidental finding of significant arterial disease should be documented with gray scale, color, and
spectral Doppler
Duplicated Veins
 May be seen anywhere along the venous system
 If above knee, always document both in gray scale, color, and spectral Doppler
 Below knee, document both in transverse, and one or both with color Doppler
 If thrombus is evident in one or both veins complete documentation is required
 If no evidence of thrombus document only one with spectral Doppler
Labs
•
D-dimer – if increased may indicate thrombus formation
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