CCI Peripheral Venous Evaluation 4 — Questions and Answers
Question 1: The CEAP classification system for chronic venous disease uses which component to categorize clinical severity?
- C — Clinical signs (C0–C6) (Correct answer)
- E — Etiology of the disease
- A — Anatomic distribution
- P — Pathophysiology
Correct answer: C — Clinical signs (C0–C6)
The 'C' component of CEAP classifies clinical severity from C0 (no signs) through C6 (active venous ulcer).
Question 2: During a lower extremity venous reflux study, the patient should be positioned:
- Standing or reverse Trendelenburg to maximize venous filling (Correct answer)
- Supine with legs elevated 15 degrees
- Prone with feet hanging off the table
- Seated with legs horizontal
Correct answer: Standing or reverse Trendelenburg to maximize venous filling
Standing or reverse Trendelenburg positioning distends the veins with blood, making reflux easier to provoke and measure.
Question 3: Reflux in the deep venous system (femoral and popliteal veins) is defined as retrograde flow lasting longer than:
- 1.0 second (Correct answer)
- 0.5 seconds
- 0.35 seconds
- 2.0 seconds
Correct answer: 1.0 second
Deep vein reflux is defined as retrograde flow exceeding 1.0 second, a longer threshold than for superficial or perforator veins.
Question 4: A patient with post-thrombotic syndrome (PTS) would MOST likely demonstrate which duplex finding?
- Chronic thrombus with recanalization and deep venous reflux (Correct answer)
- Acute DVT with anechoic homogeneous thrombus
- Normal compressibility with spontaneous phasic flow
- Isolated superficial vein reflux only
Correct answer: Chronic thrombus with recanalization and deep venous reflux
PTS results from prior DVT causing valve destruction, leading to recanalized but incompetent deep veins with chronic reflux.
Question 5: When color Doppler shows a 'mosaic' pattern within a venous segment, this MOST likely represents:
- Turbulent flow due to partial obstruction or stenosis (Correct answer)
- Normal laminar venous flow
- Complete venous occlusion
- Arteriovenous fistula
Correct answer: Turbulent flow due to partial obstruction or stenosis
A mosaic color pattern indicates flow turbulence, which can occur with partial venous obstruction, stenosis, or extrinsic compression.
Question 6: The Giacomini vein is a venous variant BEST described as:
- A thigh extension of the small saphenous vein connecting to the great saphenous vein (Correct answer)
- A perforator connecting the GSV to the deep femoral vein
- A duplicated segment of the great saphenous vein
- The lateral accessory great saphenous vein
Correct answer: A thigh extension of the small saphenous vein connecting to the great saphenous vein
The Giacomini vein is a communicating vein that extends the SSV cranially in the posteromedial thigh to connect with the GSV.
Question 7: Which sonographic sign is used to detect a Baker's cyst (popliteal cyst) that may mimic DVT symptoms?
- Anechoic or hypoechoic fluid-filled structure posterior to the knee communicating with the joint (Correct answer)
- Echogenic intraluminal material within the popliteal vein
- Non-compressible popliteal vein with absent color flow
- Hyperechoic calcified plaque along the vein wall
Correct answer: Anechoic or hypoechoic fluid-filled structure posterior to the knee communicating with the joint
A Baker's cyst appears as a fluid-filled structure between the medial head of the gastrocnemius and semimembranosus, often communicating with the knee joint.
CCI Peripheral Venous Evaluation 4
The CEAP classification system for chronic venous disease uses which component to categorize clinical severity?