CCI Peripheral Venous Evaluation 3 — Questions and Answers
Question 1: In the context of peripheral venous evaluation, which condition is associated with May-Thurner syndrome?
- Left common iliac vein compressed by the right common iliac artery (Correct answer)
- Right common iliac vein compressed by the left common iliac artery
- Inferior vena cava compression by the aorta
- Femoral vein compression by the sartorius muscle
Correct answer: Left common iliac vein compressed by the right common iliac artery
May-Thurner syndrome occurs when the right common iliac artery crosses and compresses the left common iliac vein, predisposing to left-sided DVT.
Question 2: Which B-mode gray-scale finding suggests CHRONIC rather than acute DVT?
- Echogenic, retracted thrombus with partial recanalization (Correct answer)
- Anechoic, homogeneous intraluminal material
- Vein wall indistinguishable from thrombus
- Distended vein lumen with soft thrombus
Correct answer: Echogenic, retracted thrombus with partial recanalization
Chronic DVT typically appears echogenic (bright) and contracted, often with partial recanalization channels visible on color Doppler.
Question 3: A perforator vein is considered hemodynamically significant when outward (deep-to-superficial) reflux duration exceeds:
- 0.35 seconds (Correct answer)
- 0.5 seconds
- 1.0 second
- 2.0 seconds
Correct answer: 0.35 seconds
Perforator vein reflux is considered pathologic when outward flow lasts longer than 0.35 seconds after calf compression release.
Question 4: Which structure is identified at the confluence of the anterior tibial, posterior tibial, and peroneal veins?
- Tibial-peroneal trunk (Correct answer)
- Popliteal vein
- Common femoral vein
- Gastrocnemial vein
Correct answer: Tibial-peroneal trunk
The tibial-peroneal trunk forms below the knee where the posterior tibial and peroneal veins join before entering the popliteal vein.
Question 5: When performing a venous duplex exam, the Valsalva maneuver is MOST useful for evaluating:
- Competence of the saphenofemoral junction valve (Correct answer)
- Calf vein thrombosis
- Perforator vein diameter
- Popliteal vein compressibility
Correct answer: Competence of the saphenofemoral junction valve
The Valsalva maneuver increases intra-abdominal pressure and tests valve competence at the SFJ by provoking reflux if valves are incompetent.
Question 6: A finding of 'spontaneous' venous flow on duplex ultrasound means:
- Flow is present without any patient maneuver or compression (Correct answer)
- Flow appears only after distal augmentation
- Flow reverses spontaneously during quiet respiration
- Flow is detected only with color Doppler, not spectral
Correct answer: Flow is present without any patient maneuver or compression
Spontaneous venous flow is detected at rest without requiring augmentation, indicating adequate venous patency and flow volume.
Question 7: Which duplex finding at the popliteal vein is MOST consistent with extrinsic compression rather than intrinsic DVT?
- Extrinsic mass visible; vein is compressible but flow is reduced (Correct answer)
- Non-compressible vein with intraluminal echogenicity
- Spontaneous phasic flow absent bilaterally
- Color Doppler shows reversal of flow direction
Correct answer: Extrinsic mass visible; vein is compressible but flow is reduced
Extrinsic compression typically shows a compressible vein with an adjacent mass (e.g., Baker's cyst) causing flow reduction but no intraluminal thrombus.
CCI Peripheral Venous Evaluation 3
In the context of peripheral venous evaluation, which condition is associated with May-Thurner syndrome?