CCI - Cardiovascular Credentialing International Peripheral Venous Evaluation Questions and Answers

Question 1

A sonographer performing a lower extremity venous duplex exam on a patient with unilateral leg swelling obtains a continuous, non-phasic Doppler waveform from the left common femoral vein. The right common femoral vein displays a normal phasic waveform. This finding is most suggestive of which condition?

Accepted Answer

Obstruction in the left iliac vein or inferior vena cava

Answer

Normal venous flow in the lower extremities is phasic with respiration, decreasing with inspiration and increasing with expiration. A continuous, non-phasic waveform indicates a loss of this respiratory variation, which is typically caused by a more proximal obstruction, such as DVT or extrinsic compression (e.g., May-Thurner syndrome) in the iliac veins or IVC, preventing the pressure changes from the thorax from reaching the more distal veins.

Question 2

During a venous reflux study, the sonographer documents retrograde flow in the great saphenous vein (GSV) that lasts for 950 milliseconds following distal augmentation. How should this finding be classified?

Accepted Answer

Pathologic superficial venous reflux

Answer

The standard threshold for diagnosing pathologic venous reflux in the superficial venous system (including the great and small saphenous veins) is a retrograde flow duration of greater than 500 milliseconds (>0.5 seconds). Since 950 ms is significantly longer than 500 ms, this finding indicates valvular incompetence and is classified as pathologic superficial venous reflux.

Question 3

Which of the following is considered the most reliable and primary sonographic criterion for diagnosing an acute deep vein thrombosis (DVT)?

Accepted Answer

Lack of complete coaptation of the vein walls with transducer pressure

Answer

While other findings like echogenic material, absent Doppler signals, and venous distention are supportive signs, the primary and most definitive diagnostic criterion for DVT is the inability to fully compress the vein walls together (coaptation) with gentle transducer pressure. A patent vein will collapse completely, whereas a vein containing thrombus will not.

Question 4

A patient is referred for a peripheral venous evaluation due to a high clinical suspicion for DVT. The factors contributing to thrombus formation, known as Virchow's Triad, consist of which of the following three elements?

Accepted Answer

Venous stasis, endothelial injury, and hypercoagulability

Answer

Virchow's Triad describes the three broad categories of factors that are thought to contribute to thrombosis. These are: 1) venous stasis (slow blood flow), 2) endothelial injury (damage to the vein wall), and 3) a hypercoagulable state (blood that is prone to clotting).

Question 5

When scanning the popliteal fossa from a posterior approach, what is the typical anatomical relationship between the popliteal vein and the popliteal artery on the ultrasound screen?

Accepted Answer

The vein is superficial (closer to the transducer) to the artery

Answer

When imaging from the posterior aspect of the knee (the popliteal fossa), the popliteal vein is typically located superficial to the popliteal artery. Therefore, on the ultrasound display, the vein will appear closer to the top of the screen than the artery.

CCI - Cardiovascular Credentialing International Practice Test

CCI - Cardiovascular Credentialing International Practice Test

CCI - Cardiovascular Credentialing International Peripheral Venous Evaluation Questions and Answers