Venous Mapping & Preoperative Assessment Flashcards

Which duplex ultrasound finding confirms successful endovenous thermal ablation of the GSV at follow-up?

Answer: Occlusion or fibrosis of the treated vein segment

Successful endovenous ablation results in thrombotic occlusion followed by fibrosis of the treated segment, confirmed by the absence of compressibility and flow on duplex imaging.

Endovenous heat-induced thrombus (EHIT) is a recognized complication of which vascular procedure?

Answer: Endovenous thermal ablation (laser or radiofrequency)

EHIT occurs when thermally induced thrombus propagates from the treated superficial vein into the deep venous system at the saphenofemoral or saphenopopliteal junction.

In the EHIT classification, Class 2 is defined as thrombus extending into the common femoral vein occupying what proportion of the lumen?

Answer: Less than 50% of the lumen

EHIT Class 2 describes thrombus extending into the common femoral vein but occupying less than 50% of the lumen, distinguishing it from Class 3 (≥50%) and Class 4 (complete occlusion/DVT).

What is the most common cause of recurrent varicose veins following surgical GSV ligation and stripping?

Answer: Neovascularization at the saphenofemoral junction

Neovascularization — the formation of new small tortuous vessels at the groin scar — is the most frequently identified mechanism of recurrence after surgical SFJ ligation.

A preoperative vein mapping documents a GSV diameter of 1.8 mm throughout its course. What is the most appropriate recommendation?

Answer: Recommend an alternative conduit such as arm vein or synthetic graft

A GSV measuring 1.8 mm is below the 3.0 mm minimum threshold for bypass conduit use, and the surgeon should be advised to use an alternative such as upper extremity vein or a prosthetic graft.

Which augmentation technique is recommended when assessing superficial venous reflux with the patient in the standing position?

Answer: Distal limb compression and rapid release

Manual distal compression of the calf or foot followed by rapid release is the standard augmentation method for reflux testing in the standing position, generating a retrograde pressure wave.

Beyond diameter measurements, what is the single most important piece of information provided to the surgeon after GSV mapping?

Answer: Skin-marked course of the vein drawn under ultrasound guidance

Marking the GSV course directly on the patient's skin under real-time ultrasound guidance allows the surgeon to precisely locate and incise over the vein during harvest, reducing operative time and complications.