Overview of Sonography Vascular Peripheral Vein Assessment, Protocols, and Interpretation
Doctors often use a test called a peripheral venous ultrasound to identify and assess issues or diseases in your veins. The issues can range from immediate threats like a blood clot (acute thromboembolism) to long-term conditions like post-thrombotic syndrome and chronic venous insufficiency. This ultrasound is quick and easy to do. It’s a safe procedure that doesn’t involve any radiation exposure. When checking for a blood clot in deep veins (deep venous thrombosis, or DVT), this ultrasound is highly effective, especially for clots higher up in your body (proximal DVT). It can also highlight issues with the structure of your veins, any problems with your venous valves and reflux (a condition where the blood flows backward), and the range and pattern of the disease.
Venous thromboembolism is essentially the formation of blood clots in the veins. It occurs in approximately one in 1,000 people annually, leading to more than 250,000 hospitalizations every year in the U.S. DVT in the iliofemoral veins can lead to frequent hospital readmissions and painful skin ulceration caused by a blood clot (post-thrombotic venous ulceration). People at risk of this issue generally have slow blood flow (stasis of blood flow), damaged inner lining of blood vessels (endothelial injury), and blood prone to clot, meaning it coagulates easily (hypercoagulability).
Post-thrombotic syndrome (PTS) refers to long-term complications that arise from blood clots in the veins. Between 15% and 50% of people with symptomatic DVT develop PTS, typically within one to two years. PTS can result from the vein blockage or inflammation leading to damage to the venous valves, causing reflux and high blood pressure in the veins.
Now, chronic venous insufficiency (CVI) denotes a situation where the veins don’t return blood to the heart properly. It usually affects the superficial veins (the veins closer to the skin’s surface). CVI is influenced by genetics and risk factors like age, being female, obesity, and standing for a long time. It is seen more often in younger individuals. Approximately a quarter to a third of women and 10% to 20% of men have varicose veins, an early sign of CVI. Around 5% of people have severe skin changes such as hyperpigmentation, lipodermatosis, and ulceration.
If you have PTS or CVI, you may experience symptoms like pain, cramps, itching, swelling, skin changes, and venous ectasia, which is the dilation of your small veins. Your doctor may use something called the Villalta score to determine if you have PTS and decide on the best treatment. For CVI, you might be assessed using the CEAP scale. These scores rely heavily on understanding your medical history and thoroughly examining your current physical state. The ultrasound helps confirm any diagnosis, shows the extent of the disease, how it has progressed, and how well your treatment is working.
Anatomy and Physiology of Sonography Vascular Peripheral Vein Assessment, Protocols, and Interpretation
Your body has a network of veins that carry blood back to your heart. These veins can be divided into two major systems: a deep system, located beneath a layer of muscle, and a superficial system, found above this layer. There are also some veins known as perforator or communicating veins that connect these two systems and help direct blood to the deep veins.
Not all veins are exactly alike. In fact, veins often differ more than arteries do, so knowing the typical landmarks and individual variations of your veins is crucial in understanding how your circulatory system works. One main difference between veins and arteries is that veins are less muscular and more flexible. They also commonly run closer to your skin surface and have one-way valves that prevent blood from flowing backwards. Furthermore, these veins transport blood back towards the heart through a combination of these one-way valves, muscle contractions, heart pumping, and changes in chest pressure caused by breathing.
In the legs, the main veins of the superficial system include the great saphenous vein and the lesser saphenous vein. The great saphenous vein runs starting from your foot, up the inner side of your leg and thigh and meets with a deep vein at the top of your thigh. The smaller saphenous vein, on the other hand, starts on the outer side of your foot, runs up behind your ankle and along the back of your leg. At knee level, this vein usually joins with a deep vein, but it can also merge with the great saphenous vein or continue up the thigh.
The important veins of the deep system in your lower leg include the anterior tibial, posterior tibial, and peroneal veins. These veins often appear in pairs, they merge at various points up the leg and thigh to finally form the femoral and iliac veins in the thigh and pelvis region.
Blood flows from the superficial veins into the deep system through about 150 small veins with one-way valves called perforator veins.
The veins in your arms also vary in terms of their number and exact position. One main vein, the brachial vein, runs along the forearm and upper arm, often alongside the artery and nerves of the arm. This vein is formed by the merging of two smaller veins in your forearm. As your brachial vein runs up your arm, it changes names according to the region it’s passing through, ultimately becoming the subclavian vein and then the brachiocephalic vein when it reaches your upper chest and neck region.
Lastly, in the superficial system of your arms, there are two important veins called the cephalic and basilic veins. The cephalic vein runs along the front and outer side of your forearm and arm, while the basilic vein runs along the front and inner side of your forearm and arm.
Why do People Need Sonography Vascular Peripheral Vein Assessment, Protocols, and Interpretation
If a medical professional suspects that a patient may have a severe blood clot disorder – either deep vein thrombosis (DVT) or a pulmonary embolism (PE) – they will need to conduct an evaluation. Deep vein thrombosis means a blood clot has formed in the deep veins, usually in the leg, which can cause pain and swelling, and can lead to a pulmonary embolism if the blood clot breaks off and travels to the lungs. A pulmonary embolism is a very serious condition that can cause severe breathing problems and even death. The doctor will use different tools or tests like the ‘Pulmonary Embolism Rule-out Criteria’ or ‘Wells Score’ in combination with a special blood test called D-dimer to know if such dangerous blood clots could be present.
In other scenarios, doctors may conduct an examination if a patient shows signs of chronic venous insufficiency. This condition makes it difficult for the leg veins to send blood back to the heart. Symptoms of this might include varicose veins, which are enlarged, swollen, and twisting veins. These could cause discomfort or may just be observed in patients who are contemplating their treatment options. Other symptoms may include signs of venous hypertension – when pressure in the veins becomes too high. This can show up as swelling, skin changes, or ulcers on the legs. If patients are again experiencing problems after undergoing treatment for this condition, this might also call for an evaluation.
Equipment used for Sonography Vascular Peripheral Vein Assessment, Protocols, and Interpretation
Doctors use a certain tool called a linear transducer, which operates at a frequency between 5.0 to 7.5 MHz or even higher. This is the preferred instrument. In some more challenging situations, they might use a different tool called a curved transducer. This operates at a frequency between 3.5 to 5.0 MHz. The advantage of using the curved transducer is that it gives a deeper and broader view of the area they’re inspecting.
Who is needed to perform Sonography Vascular Peripheral Vein Assessment, Protocols, and Interpretation?
The majority of peripheral ultrasounds, which are the tests that look at areas of your body like your arms and legs, are done by ultrasound technicians. These are professionals specially trained to use ultrasound machines. However, any doctor who has gone through the right amount of training can also conduct these tests. Doing an ultrasound at the point of care, which is where the patient gets their health services, can be helpful. If carried out by qualified providers, this can assist in prioritizing certain treatments or care. This means that doctors can quickly see the results of your ultrasound, allowing them to make urgent decisions about your healthcare more effectively.
How is Sonography Vascular Peripheral Vein Assessment, Protocols, and Interpretation performed
If your doctor needs to check if you have a serious condition called deep vein thrombosis (DVT), they will likely use a test called a duplex ultrasound. This test uses sound waves to create images of the inside of your body and show blood flow in your veins. DVT is a blood clot in a deep vein, usually in the leg.
During the test, you will lie down with your head slightly raised. This allows blood to pool in your veins and gives the doctor a better look. You will bend your leg in a ‘frog-leg’ position and then your doctor will apply the ultrasound to different areas, from your groin to your calf. About 10% of people have an extra vein in their thighs, so if you have this, the doctor will also check this vein.
The doctor puts a tool on your skin that applies gentle pressure to your veins. If the vein doesn’t collapse under this pressure, it might mean there’s a clot. The color on the ultrasound image shows how well blood is flowing, which helps the doctor determine if there’s a blockage. The doctor may also check for any clots in the superficial vein near the groin, as they can often lead to DVT.
The doctor could also check the veins in your arm using the same method. For this, you lie on your back and turn your head away from the side being looked at. The doctor may also ask you to take a deep breath to see if the veins in your neck respond correctly, because if there’s a clot, the veins may not change as expected. You can have clots in these veins too.
The ultrasound also shows the state of the clot. A fresh clot might look hollow inside, and the vein around it may be expanded. If the clot is old, it could look denser and may be attached to the vein wall, and the vein may look smaller.
Your doctor might also use this test to check for a condition called venous insufficiency. This is when your veins have trouble sending blood from your limbs back to your heart. To check for this, you will be asked to stand with weight on the leg not being tested, bend your knee a bit and relax the muscles in your leg. The test checks for blood flow in both deep and superficial veins in your legs.
If your doctor finds any veins bigger than the normal size or any blood flow that lasts longer than normal, this might indicate venous insufficiency. It is crucial that the same sequence of steps is followed everytime you get checked for this to ensure accurate comparison of results over time.
What Else Should I Know About Sonography Vascular Peripheral Vein Assessment, Protocols, and Interpretation?
Acute Deep Vein Thrombosis (DVT) and chronic venous disease, which affect veins in your body, are common and can have significant impacts on a person’s health, life span, and quality of life. The VEINES study found a relationship between varicose veins (twisted, enlarged veins near the skin’s surface), venous disease (issues with the veins’ normal functioning), and decreased quality of life scores.
A duplex ultrasound, which uses sound waves to create images of blood flow within your veins, can accurately and quickly assess vein disease. It can detail the severity of the disease, helping doctors determine the best treatment method. This test is non-invasive (doesn’t involve entering the body or breaking the skin) and exposes the patient to no radiation. Additionally, it is simple, widely available, and easy to learn how to perform, although it can be costly.
