p://www.ultrasoundpaedia.com/normalveins/varicose-veins/t
Anatomy
• The plantar digital veins-rise from the plexuses
on the plantar surfaces of the digits
-join dorsal digital veins-form 4 metatarsal
veins
- communicate by perforating veins to form
the deep plantar venous arch.
• -the medial and lateral plantar veins
communicate with the great and small
saphenous veins(GSV &SSV) unite behind the
medial malleolus to form the posterior
tibial(PTV)
• The PTVs are paired and run medially in the calf near
the tibia accompanied by the PTA and arise via
tributaries between the medial malleolus and the
Achilles tendon at the ankle.
• The Peroneal veins are paired -run deeper in the calf
parallel to the PTVs through most of the calf adjacent
to the fibula
• The anterior tibial vein(ATV) are the upward
continuation of the venae comitantes of the dorsal
pedis, they join the Tibioperoneal trunk to form the
Popliteal vein
• The popliteal vein(POPV) –formed by the junction of
the ATV and TP trunk at the lower border of the
popliteus -ascends through the popliteal fossa and
becomes the femoral vein in the adductor canal.
Contains 4 valves and commonly dupplicated
• The femoral vein (FV)runs upward along with
femoral artery(FA) lies lateral to the artery-lies
medial at the inguinal ligament-joined by the
deep femoral(profunda femoris)towards its
termination into the common femoral vein.
• The deep femoral vein(PF)receives tributaries
corresponding to the perforating branches
• The common femoral Vein (CFV) is joined by the
GSV at the junction before it becomes the
external Iliac vein
• The GSV –arises from medial marginal vein of the
dorsum of the foot- runs in front of the tibialmalleolus along the medial side of the legs in
relation to the saphenous nerve – ends into the
CFV 3cm below the inguinal ligament.
• The small saphenous vein(SSV) originates from
the lateral foot-passes posteriorly lateral to the
achilles tendon - centrally along the superficial
aspect of the calf between two heads of the
gastrocnemius muscle and drains in the POPV.
• The superficial venous system is a complex web
like network of interconnecting veins
• The foot perforators
• Ankle perforators (Crokett’s)
• Calf perforators
• Knee perforators (Boyd’s)
• Thigh perforators(Hunter’s/Dodd’s)
Source:http://venacure-evlt.com/endovenous-laser-vein-treatment/procedure/venousanatomy/
Deep veins and Superficial veins
Deep vein thrombosis and
Thrombophlebitis
Ultrasound of the leg for suspected DVT
• EQUIPMENT SELECTION
• A 3-9 or 12 MHz linear transducer, a curve –
linear transducer can be used for the Iliac
veins and for calf veins in obese/large patient
• Low velocity range to demonstrate good
colour filling of the vessels
• Low wall filter and wide sample volume to
gain as much information as possible
Scanning Protocol
• The leg under examination should be accessed from the groin to
the ankle.
• Dual imaging is necessary to show one side normal and other side
demonstrating compression
• B-mode
• Transverse section -starting at the inguinal canal-examining the:
• Common femoral vein, Greater saphenous junction, femoral and
profunda femoral vein, femoral vein proximal, mid and distal into
the adductor canal, compressing the veins every 2-3 centimeters.
• Colour and spectral Doppler in longitudinal showing the –
• Common femoral vein, Greater saphenous junction,
• bifurcation of the deep and femoral veins,
• femoral vein-proximal, mid and distal
• B-mode transverse images of the Popliteal vein,
proximal and distal demonstrating compression
• Longitudinal colour and spectral Doppler of the
popliteal vein
• B-mode transverse images of the posterior tibial
and peroneal veins demonstrating compression
• Longitudinal colour and spectral Doppler images
of the posterior tibial and peroneal veins
• B-mode images of the medial and lateral
gastrocnemius, soleal, long and small saphenous
veins
• Venous dysfunction develops when the venous
return is impaired
• -due to abnormalities from within the deep
/superficial veins or a combination of venous
obstruction-thrombotic or non thrombotic or
from valvular incompetence, which maybe
segmental or involving the entire length of the
vein
• Patient’s symptoms-vary-from non obvious-to
pain, redness, oedema, dilatation of the
superficial veins of the affected leg. Homans signpain in the calf with forced dorsiflexion of the
foot
Risk factors
• Malignancy
• Long distance travel(by air or by road without
excise)
• Pregnancy
• Obesity
• Post surgery or trauma
• Immobilisation
• Past history of DVT
• Contraceptive pills
• Age-increasing age increases the risk of
developing DVT.
• Coagulation disorders(congenital/acquired)
• Septicaemia
• Past history of DVT
• Hormonal replacement therapy
• Stroke
• Stacis of blood flow
• Smoking.
Criteria for diagnosing thrombosis
• Inability to compress the vein
• Visible intraluminal clot-fresh echolucent
-old increasingly echogenic
• Absence of flow in the vein
• Diameter of the vein-increases in acute phase-smaller
in chronic phase.
• Loss of change in diameter in the CFV during valsalva
manoeuvre
• Minimal augmentation
• Increased flow in the superficial veins-they act as
collaterals
Pathology
• Baker’s cyst(semi-membranosis-gastrocnemial
burser)in the medial popliteal fossa
• Cellulitis, Lymphoedema, Lymphangitis
• Superficial venous thrombosis of varices and
of the great and small saphenous veins
• Calf muscle tear
• Deep vein thrombosis
• Pulmonary embolism
www.enurse-careplan.cohttp://m
Sample images showing normal compressible deep veins and thrombus in the short
saphenous vein(thrombophlebiti the and sapheno-popliteal junction propagating into
the deep vein(popliteal). Thrombus also seen in superficial varicose veins
Veins. Diagnosis deep vein thrombosis with thrombophlebitis.
References
Hamper, M.U., M.R. DeJong, and L.M. Scoutt. 2007.
Ultrasound evaluation of the lower extremity veins.
Radiologic Clinics of North America 45: 525-545.
• Kupinski, A.M. 2013. Diagnostic medical sonography.
The vascular system. Philadelphia: J.K. Stegman3
• Myers, K.A and A. Clough. 2004. Making sense of
vascular ultrasound a hands on guide. London: Arnold
• Zwiebel, W.J., and J. Pellerito. 2005. Introduction to
Vascular Ultrasound. 5th ed. Philadelphia: W.B. Sanders