CCI Peripheral Venous Evaluation 5 — Questions and Answers
Question 1: In duplex evaluation of suspected upper extremity DVT, which vein is MOST commonly affected by catheter-related thrombosis?
- Subclavian or axillary vein (Correct answer)
- Cephalic vein at the shoulder
- Basilic vein at the elbow
- Internal jugular vein
Correct answer: Subclavian or axillary vein
Catheter-related upper extremity DVT most commonly involves the subclavian or axillary vein due to central line placement routes.
Question 2: When evaluating calf veins, the paired posterior tibial veins travel adjacent to which artery?
- Posterior tibial artery (Correct answer)
- Anterior tibial artery
- Peroneal artery
- Popliteal artery
Correct answer: Posterior tibial artery
The paired posterior tibial veins accompany the posterior tibial artery, running in the deep posterior compartment of the calf.
Question 3: Which maneuver is MOST effective for demonstrating reflux in the small saphenous vein (SSV) at the popliteal fossa?
- Calf compression and release while patient stands (Correct answer)
- Proximal thigh tourniquet application
- Distal foot compression only
- Patient performs 10 calf raises
Correct answer: Calf compression and release while patient stands
Calf compression with rapid release in the standing patient creates the pressure reversal needed to demonstrate SSV valve incompetence at the popliteal level.
Question 4: A patient with a history of DVT returns for follow-up. Duplex shows a recanalized femoral vein with echogenic walls and intraluminal webs. This BEST describes:
- Chronic post-thrombotic changes (Correct answer)
- Fresh acute DVT extending into a recanalized segment
- Normal femoral vein appearance
- Venous aneurysm formation
Correct answer: Chronic post-thrombotic changes
Recanalized vein with echogenic walls and synechiae (webs) are hallmark duplex findings of chronic post-thrombotic changes.
Question 5: The 'double channel' sign on duplex ultrasound in a venous segment MOST likely indicates:
- Duplicated vein or partial recanalization of a thrombosed vein (Correct answer)
- Arteriovenous fistula
- Normal variant twin vein anatomy only in the popliteal fossa
- Venous varix formation
Correct answer: Duplicated vein or partial recanalization of a thrombosed vein
A double-channel appearance can represent either a duplicated vein or partial recanalization of a previously thrombosed vessel with residual intraluminal material.
Question 6: Which clinical scenario BEST indicates the need for a bilateral lower extremity venous duplex exam rather than unilateral?
- Suspected DVT in a patient with bilateral leg swelling of unknown cause (Correct answer)
- Unilateral calf pain after a long flight
- Pre-operative mapping for varicose vein ablation on the left leg
- Follow-up exam for known right popliteal DVT on anticoagulation
Correct answer: Suspected DVT in a patient with bilateral leg swelling of unknown cause
Bilateral leg swelling without a clear unilateral cause warrants bilateral examination to rule out bilateral DVT or central obstruction.
Question 7: Which of the following BEST describes the role of air plethysmography (APG) in venous evaluation?
- Quantifies venous reflux and calf muscle pump function using volume changes (Correct answer)
- Directly images thrombus location within deep veins
- Measures venous wall compliance by intraluminal pressure
- Detects perforator reflux using color Doppler imaging
Correct answer: Quantifies venous reflux and calf muscle pump function using volume changes
APG uses air-filled cuffs to measure limb volume changes during standing, walking, and tip-toe exercises to quantify reflux and calf pump ejection fraction.
CCI Peripheral Venous Evaluation 5
In duplex evaluation of suspected upper extremity DVT, which vein is MOST commonly affected by catheter-related thrombosis?