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Venous Duplex Above and Below The Diaphragm Patrick A Washko BSRT,RDMS,RVT,FSVU Coordinator /Technical Director UNC Rex healthcare Peripheral Vascular lab North Carolina Heart and vascular Hospital Raleigh, NC UNC Rex Healthcare North Carolina heart and Vascular Hospital • S. Wayne Smith M.D.RVT,RDMS,FSVM,RVPI • Patrick A Washko BSRT,RDMS,RVT,FSVU • Robert Mendes M.D • Brian Stull, RDMS,RVT • Lauren Odom RDMS,RVT • Brandy O’hara RDMS, RVS • Elvira Castellanos RDMS,RVT • Hillary Sawyer RVT • Darryl Smith RDMS,RVT • Lauren Littenden BS, RVT • OlusegunOsinbowale, M.D.RVPI • Jim Morgan MS, RVT • Liliana Nanez M.D.RPVI • Dorian de Frietas M.D. ,RVPI • Jason Kim M.D. ,RVPI • Martyn Knowles M.D. RPVI • Aaron Thomas, P.A.C, RVT • Sharon Wertz RDMS,RDCS,RVS • Kelly Edwards RDMS • Tara Hatley RDMS • Daniel Sherril RVT • Anna Moore BS RDMS • Kristen Stahura BS RVT Diagnostic Approach to Acute Deep Venous Thrombosis • >1 million patients seek medical care per year for leg pain and/or swelling • Approximately 20% of these are diagnosed with DVT Wells, et.al JAMA .2006 295(2) :199-207 VTE Until 1990’s VTE ( DVT) was considered primarily as a complication of hospitalization for major surgery ( or associated with late stage of terminal illness ) To Circulation, Vol 107 No 23 June 17 2003 Venous Thromboembolism ( VTE) • The precise number of people affected by DVT/PE is unknown, although as many as 900,000 people could be affected (1 to 2 per 1,000) each year in the United States. • Estimates suggest that 60,000-100,000 Americans die of DVT/PE (also called venous thromboembolism). – 10 to 30% of people will die within one month of diagnosis. – Sudden death is the first symptom in about one-quarter (25%) of people who have a PE. • Among people who have had a DVT, one-half will have long-term complications (post-thrombotic syndrome) such as swelling, pain, discoloration, and scaling in the affected limb. • One-third (about 33%) of people with DVT/PE will have a recurrence within 10 years. • Approximately 5 to 8% of the U.S. population has one of several genetic risk factors, also known as inherited thrombophilias in which a genetic defect can be identified that increases the risk for thrombosis. 2010 Apr;38(4 Suppl):S495-501. doi: 10.1016/j.amepre.2009.12.017. Venous thromboembolism: a public health concern. MG, Hooper WC, Critchey SE, Ortel TL . DVT Pre-Test Probability Assessment of Outpatients with Clinical Suspicion of DVT • Acute Limb Swelling - involved extremity 2 cm or greater difference in circumference Documented previous history of DVT • Malignancy • Recent surgery • Hypercoagulable state • CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996 DVT Clinical Assessment of Outpatients with Suspicion of DVT: 438 Outpatients • 153 had acute swelling with 2 cm – circumference difference 65 (42%) were positive for DVT by Venous – Duplex Ultrasonography CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996 DVT Clinical Assessment of Outpatients with Suspicion of DVT: 99 outpatients with at least one risk • factor, but without >2 cm circumference difference 38 (37%) were positive for DVT by • Venous Duplex Ultrasonography CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996 DVT Clinical Assessment of Outpatients with Suspicion of DVT: 137 outpatients with no acute swelling • and no risk factors for DVT 134 (98%) had no DVT by Venous Duplex • Ultrasonography CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996 DVT Clinical Assessment of Outpatients with Suspicion of DVT: 31 outpatients seen with cellulitis, • none had DVT 44 outpatients with chronic swelling > • 4 wks 1 acute DVT  2 chronic DVT  CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996

Description:
Sudden death is the first symptom in about one-quarter (25%) of people who have a PE. Paralysis, paresis, recent plaster immobilization of lower ext . Upper Extremity Venous Anatomy. • Upper vs Lower. • More cardiac pulsatility in the upper extremity. ( normal ). • Direction of flow. • Con
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Venous Duplex Above and Below The Diaphragm PDF

108 Pages·2017·6.45 MB·English
by  Washko, Patrick
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Venous Duplex Above and Below The Diaphragm Patrick A Washko BSRT,RDMS,RVT,FSVU Coordinator /Technical Director UNC Rex healthcare Peripheral Vascular lab North Carolina Heart and vascular Hospital Raleigh, NC UNC Rex Healthcare North Carolina heart and Vascular Hospital • S. Wayne Smith M.D.RVT,RDMS,FSVM,RVPI • Patrick A Washko BSRT,RDMS,RVT,FSVU • Robert Mendes M.D • Brian Stull, RDMS,RVT • Lauren Odom RDMS,RVT • Brandy O’hara RDMS, RVS • Elvira Castellanos RDMS,RVT • Hillary Sawyer RVT • Darryl Smith RDMS,RVT • Lauren Littenden BS, RVT • OlusegunOsinbowale, M.D.RVPI • Jim Morgan MS, RVT • Liliana Nanez M.D.RPVI • Dorian de Frietas M.D. ,RVPI • Jason Kim M.D. ,RVPI • Martyn Knowles M.D. RPVI • Aaron Thomas, P.A.C, RVT • Sharon Wertz RDMS,RDCS,RVS • Kelly Edwards RDMS • Tara Hatley RDMS • Daniel Sherril RVT • Anna Moore BS RDMS • Kristen Stahura BS RVT Diagnostic Approach to Acute Deep Venous Thrombosis • >1 million patients seek medical care per year for leg pain and/or swelling • Approximately 20% of these are diagnosed with DVT Wells, et.al JAMA .2006 295(2) :199-207 VTE Until 1990’s VTE ( DVT) was considered primarily as a complication of hospitalization for major surgery ( or associated with late stage of terminal illness ) To Circulation, Vol 107 No 23 June 17 2003 Venous Thromboembolism ( VTE) • The precise number of people affected by DVT/PE is unknown, although as many as 900,000 people could be affected (1 to 2 per 1,000) each year in the United States. • Estimates suggest that 60,000-100,000 Americans die of DVT/PE (also called venous thromboembolism). – 10 to 30% of people will die within one month of diagnosis. – Sudden death is the first symptom in about one-quarter (25%) of people who have a PE. • Among people who have had a DVT, one-half will have long-term complications (post-thrombotic syndrome) such as swelling, pain, discoloration, and scaling in the affected limb. • One-third (about 33%) of people with DVT/PE will have a recurrence within 10 years. • Approximately 5 to 8% of the U.S. population has one of several genetic risk factors, also known as inherited thrombophilias in which a genetic defect can be identified that increases the risk for thrombosis. 2010 Apr;38(4 Suppl):S495-501. doi: 10.1016/j.amepre.2009.12.017. Venous thromboembolism: a public health concern. MG, Hooper WC, Critchey SE, Ortel TL . DVT Pre-Test Probability Assessment of Outpatients with Clinical Suspicion of DVT • Acute Limb Swelling - involved extremity 2 cm or greater difference in circumference Documented previous history of DVT • Malignancy • Recent surgery • Hypercoagulable state • CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996 DVT Clinical Assessment of Outpatients with Suspicion of DVT: 438 Outpatients • 153 had acute swelling with 2 cm – circumference difference 65 (42%) were positive for DVT by Venous – Duplex Ultrasonography CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996 DVT Clinical Assessment of Outpatients with Suspicion of DVT: 99 outpatients with at least one risk • factor, but without >2 cm circumference difference 38 (37%) were positive for DVT by • Venous Duplex Ultrasonography CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996 DVT Clinical Assessment of Outpatients with Suspicion of DVT: 137 outpatients with no acute swelling • and no risk factors for DVT 134 (98%) had no DVT by Venous Duplex • Ultrasonography CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996 DVT Clinical Assessment of Outpatients with Suspicion of DVT: 31 outpatients seen with cellulitis, • none had DVT 44 outpatients with chronic swelling > • 4 wks 1 acute DVT  2 chronic DVT  CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996

Description:
Sudden death is the first symptom in about one-quarter (25%) of people who have a PE. Paralysis, paresis, recent plaster immobilization of lower ext . Upper Extremity Venous Anatomy. • Upper vs Lower. • More cardiac pulsatility in the upper extremity. ( normal ). • Direction of flow. • Con
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