1-use linear array probe 5 - 7.5 mhz.
2-patient supine with slight abduction of the thigh 10-15 degree.
3-gel applied from groin to adductor canal.
4-first,imaging done in transverse plane to identify femoral vein(medial) and artery(lateral).
5-spectral doppler analysis of both vessels.
artery--->triphasic wave form.
vein --->monophasic wave form.
6-examine external iliac vein using spectral wave form by one or the two following
a - normally , it is monophasic wave form with increase with expiration and decrease with inspiration.
-absence of this variation means----->proximal thrombosis or
----->proximal compression of the vein.
b-by valsalva maneuver.
7-by this point,imaging will be done by longitudinal scan.
8-examination of--->common femoral vein.
--->superficial femoral vein.
--->profunda femoris vein.
we can increase doppler flow by--->compression technique
and by--->by power doppler imaging.
8-turn patient in lateral decubitus with knee flexed by 20-25 degrees.
9-popliteal vein is seen anterior to popliteal artery.
10-examine popliteal vein up to adductor canal and inferiorly to tibio-peroneal trunk.
11-diagnostic criteria
*sponteneous flow:
present in patent vessel
not present in thrombotic vessel.
*intraluminal reflective material:
not present in patent vessel.
present in thrombotic vessel.
*response to distal augmentation:
present in patent vessel.
not present in thrombotic vessel.
*response to probe compression:
present in patent vessel.
not present in thrombotic vessel.
*venous dilatation:
not present in patent vessel.
present in thrombotic vessel.
*spectral wave form:
present,phasic in patent vessel.
not present in thrombotic vessel.
iliac assessment:
spectral variation is seen in patent vessel.
not seen in thrombotic vessel.
response to valsalva maneuver is seen in healthy vein
not present in thrombotic vessel.
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