Duration: 5 minutes
These educational videos are intended to instruct the learner how to locate the distal great saphenous vein, the posterior accessory saphenous vein, perforator veins, and other veins in the lower extremity utilizing ultrasounds. Locating these veins, obtaining their measurements, and understanding their characteristics is vital to assessing a patient with lipodermatosclerosis, a condition associated with venous insufficiency. Understanding each patient’s individual situation is a key step in determining treatment options.
This is an ultrasound scanning video for location of the distal great saffinous vein, the posterior accessory saffinous vein, formerly called the posterior arch branch and perforator veins. This is the GSV great saffinous vein within the fascial compartment with the posterior accessory saffinous vein going superiorly. This is a posterior tibial perforating vein connecting from the posterior accessory saffinous vein. The perforating vein that breaks a superficial fascia measures 0.52 centimeters in diameter. Now the reflex will be measured. With distal compression, augmentation demonstrated normal valve closure immediately after compression. GSV seen within the saffinous compartment between the superficial fascia and the deep muscular fascia. The PASV posterior accessory saffinous vein, is the vein closest to the top of the screen. Following the PASV posterior accessory sainous vein distally down the leg. A perforator is noted, coursing through the superficial fascia and the deep fascia to the posterior tibial veins, PTVs, located just below the deep muscular fascia. Measurement of the perforator at the fascial brake is 0.24 centimeters, which is a normal size perforator. With distal augmentation with Doppler on demonstrates normal valve closure with the augmentation. This demonstrates no reflux in the perforator. The perforator coursed from superficial to deep directly into the posterior tibial veins located directly below the deep muscular fascia. The posterior tibial veins are paired with an artery between, giving them a barbell appearance. The PTV's posterior tibial veins compress with non-compression of the artery. Scanning down to the medial mallelius, you will note the PTVs, posterior tibial veins. PTVs compressed nicely. Demonstrating how to look for the posterior tibial veins and perineal veins, you will look for landmarks. First is the shadow of the tibia, and below is the shadow of the fibula. Below the bright white echogenic line is the paired posterior tibial veins. GSV at the knee, coursing down the leg, the PASV posterior accessory sainous vein, breaks off of the GSV superiorly, with a lot of branches and tributaries off of the PASV. Posterior accessory saffinous vein closest to the top of the screen with the GSV below in the saffinous compartment. Perittibial perforating vein from the GSV through the deep muscular fascia. Perforator is within normal size of 0.26 centimeters. Pulsed Doppler with augmentation demonstrates normal valve closure with distal augmentation. No reflex scene. The GSV after the perforator is small. Posterior accessory sainous vein comes back into the GSV. GSV at the ankle. Measures 0.32 centimeters, which is a normal size. Pulse Doppler applied to the ultrasound. Dial augmentation applied twice with normal valvular response. Normal valve reaction time of 0.44 seconds.
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