Duration: 9 minutes
In this case study, Dr. Nicos Labropoulos and Dr. Adriano Souza provide step-by-step instruction on how to conduct a lower extremity ultrasound examination on a 60-year-old female presenting with complaints of mild leg discomfort that is worse at the end of the day.
Now we're going to present a pinkel case with great arous vein reflex. This is the right leg of the previous patient. And as you see has varicosities in the anterior and medial aspect of the cf. She's a female patient, 60 years old, who presented with complaints of mild discomfort, which is worse at the end of the day. She had 3 children and 4 years ago, hypertension, which controlling one medication, and no diabetes, allergies, and never smoked. She had positive family history for risk efficiency and hypertension. During a physical exam, we see uh veins on the deterior aspect of the right lower extremity, but has no edema or skin changes and no arterial pulses. We start the exam in the starting position at the sa femoral junction. Here you see the two arteries, the femoral vein and the sainous vein coming to the junction. You you see in the long view, nicely with the common femoral and saphenous vein. To the color and the Doppler test the common femoral vein, that's normal. And then we're gonna go to the femoral junction. And you see the vein here. It's a reflex on color. And the vein does not affect the common femoral. We go here at the junction with a doppler. And squeeze and the release and here the reflex is obvious, very prolonged, more than 5 seconds. Now, we're gonna check the junction there, measure the diameter, and as you can see here, it measures 7.3 millimeters smaller than the other side. Now you see the vein is medial to the vessels, and this is a great saphenous vein, unlike the previous side on the left, which was parallel and there was anterior sainus. Now we are in the upper thigh, the diameter here measures 5.2 millimeters. And I go to the long view at this level and you can see nicely now the syn is going to the top. And with a color it's easy to see the reflex. Steer the box will be better. Put the sample volume inside the vein, squeeze, hold it, and release, and here this very prolonged reflex. So the vein has reflex from the groin to the mid-thigh. Continue a bit further down. So the village has focal dilatation there. And it's coming closer to the skin. It's very nice. The valve is on the posterior wall, very eccentric, and let's make the diameter at this level, and the vein measures 8.3 millimeters. And a bit farther down the vein of the long view, see the stasis now at the area of the valve and the dilatation. And we're taking the vein above the knee area. It's a typical reflex of the valve area and below it. We are now at the area of the knee. I'm this is the diameter again. And here it is 4.9 millimeters. Going a bit further down, and following the siphonous vein, is the big tributary coming anteriorly and there is a reflex on the tributary. goes close to the skin and this is a very question so earlier in the image during the physical exam, the suction is vein at this level, is smaller, and look at the diameter and here which is only 2.6 millimeters, much smaller than the 5. Let's check out what's going on with the saf this vein now as the long view. Test the vein if there's any reflex. It's the smaller diameter of the vein, squeeze, and despite the smaller diameter, there is a reflex, you can test with the Doppler. And now you see this prolonged reflex as well, despite the smaller diameter. Now we're going to just check the vein a little bit farther down. You see a small perforator here. We are at the level of the midcalf now. The diameter is even smaller. And test the color first and it looks like maybe a bit of reflex there. And You go a bit farther down. You see the varicositis and the sainous vein, a small perforator, and I go on the long view to test the vein again. So the vein next to the bone out here. And here there's no reflex. You see you see only the blue flow and there is no red color or no flow at all during the release. And I put the Doppler there. So in the lower calf now, the media as with the leg, and you see the Doppler is very clear there is no reflex whatsoever. So you're having reflex from the groin to the mid calf and the veins further down. We're going now to the section of potial junction in the potial fossa. You see the pot at the top and the artery below. And we're going to test the Doppler, the vein. Fix the angle there. Squeeze, hold it release, and the vein is absolutely normal. There is no reflex in the deep vein. And can look a bit more proximately distally you see now the small suffers in the top, it's a bit dilated. And we take with the color, and with the color, it doesn't look like to have any backflow. So we're going to follow the very a bit further down. And it seems really becomes a bit laterally and above the public skin crease right there. Right, that's a typical Safilopo junction which is found in about 60% of people at this level. Squeeze, hold it, and the safinopolia reduction is normal. This is the pulsized floor in the artery, but there is no flaw in the popliteal vein or the small sainous vein. During the squeezing, both are blue. that's the Doppler now that's a junction. See the suffering is being there just above the female artery. And obviously there's no reflex on the Doppler like we saw with the color. The avena is really small diameter, right? You can see now here on top of the gas muscle. It's fairly superficial there. And we touch the color first and there is no reflex. So the small stuff in his vein really is, is normal on this extremity. Go a bit further down, see some tributary here. Test to do it again to make sure. And the small half in his vein has no reflex on Doppler. Then we go a bit further down. Right, the mid calf to the lower calf area, that's sa is there, small diameter and no reflex on color. Now we're gonna go back in the left leg. To understand the differences in the anatomy in the anterior accessory, and the great surface vein. On the left side here which is the deep system. And the anterior accessory further down is slightly medial, but as you go higher up, you see the anterior accessory is parallel. Now we go to the right leg, you see the great softness is medial to the deep vessels, and this is the typical difference between the two superficial veins as you see here. Now, we look at the big system, a duplication of the femoral vein, which is common. The arteries in the center, and both veins appear normal. Typically, one vein is larger than the other, is dominant, and you can see it nicely in the long view. Both veins have opposite color than the artery and normal flow. Now, we see the map of reflex on the right of the extremity. The GSV has reflex from the junction to the mid calf. This is a common pattern of reflex in the GSV. Reflex can be present in any segment of the great cyclists being trunk. However, reflex throughout the GSB is uncommon. Thank you very much.
Content on this site is intended for United States Healthcare Professionals Only
