Ultrasound mapping of the venous system

0:05 [Music] hi and welcome back to the wyoming vein specialists and casper medical energy youtube channel thanks for tuning in i'm dr charles balkeley this is jesse our lead stereotactic breast biopsy tech and this is jc one of our leads from the venus ultrasound team specifically focused on looking at lower extremity venous disease so a number of requests have come across that specifically targeted what it's like to have a venous mapping ultrasound some people aren't familiar with how invasive or non-invasive the test or procedure is and we wanted to give you an idea of what to expect after your consultation and physical examination

0:51 with respect to the venous mapping itself so we're going to get started right now okay so where we are now is we're about to start the venus mapping ultrasound and as you can see jc in her right hand has the ultrasound probe and there's some gel on the end of it which is typically warmed for our patients and jessie has her right leg turned out towards the side or in external rotation and the reason why if you remember from our prior discussions we're trying to find the greater saphenous vein which is located with its own special compartment called the fascial sheath around it it's like a saran wrap covering and it follows the inseam of your jeans okay so we're going to scan down in just a moment here but as you can see down below

1:36 jesse is kind of toeing off you can imagine if you were in a running phase that this would be the last part before your toes leave the ground however what we really want jessie to do is relax her limb down and take all of the weight off it using her rear leg kind of like a big tree trunk to hold that weight up and relax the limb we don't want any excess pressure within the venous system because when we start squeezing which we're going to go through next it's called augmentation when we start squeezing we don't want there to be any abnormal forces on that vein so this is your classic anatomy of the arterial deep venous and superficial venous system at the area of the underwear line or the inguinal

2:22 ligament or the brief line is essentially where all of these structures come together to dive down deep into the pelvis in order to return the blood from the lower extremity back to the heart this here is the common femoral vein this here is the greater saphenous vein and as jc slowly scans down we'll see another small vein that's draining into the greater saphenous vein called the anterior accessory greater saphenous vein there are a number of different normal anatomic variants and this is pretty much classic anatomy for the lower extremity venous system you can see these vessels are moving immediately next to the deep vein because these are the arterial structures we're not going to focus on those today [Music]

3:08 okay so now you've realized that there's a third person here in front of me this is jessica she's our nurse and what we're going to do now is we're going to do the compression or what's called the augmentation portion of this examination the augmentation portion of this examination is extraordinarily important it is the defining feature that allows us to characterize whether or not the veins are flowing in the appropriate direction from down below back up towards the pelvis and the orientation on the ultrasound machine is that jessie's feet are down here and her pelvis is up here so the direction of flow we want to see is it actually moving here now when jessica squeezes she's squeezing with jesse in the standing or

3:54 erect position why is that important we want this squeezing episode or this augmentation episode to replicate what jesse's body would see on a normal daily basis walking and being in the upright position that's the best way to characterize whether or not there's valvular failure or venous reflux okay so now we need to compress the entirety of the limb we want to start all the way at the top where the superficial system dives down into the deep and that's called the saphenofemoral junction jc why don't you scan up just a little bit and show us exactly where that is greater saphenous vein deep system and then go longitudinal on it and as you can see the saphenous system

4:42 dives down in and drains into the deep now jc is going to come down a little bit and we're going to see that valve structure that is so ultimately important in this examination you can see it's almost like a v lying on its side now jessica is going to squeeze either the end of jesse's thigh or jesse's calf where it's at the greatest size and that way we'll be able to watch the blood flow in the appropriate direction back towards your pelvis okay so what we're first going to do is we're going to show you the demonstration of the augmentation with jessica squeezing the calf or the distal thigh and we're going to be looking right here at that valvular structure making sure it closes normally so there are two different types of ultrasound doppler interrogation

5:30 of the venous valve this is called color doppler interrogation and when jessica squeezes we're going to see a flash of color across the screen now as we can see here that was blue blue means down down is going back towards jesse's pelvis so that's perfect in the appropriate direction and we're going to see a waveform replication of that blood flow movement go ahead and squeeze perfect now we can see here that when jessica squeezed the blood shot down or back towards the pelvis and then as the blood fell with gravity when jessica let go that valve kind of bowed back on itself and then closed and

6:16 that's absolutely perfect that's exactly what the valves in the lower extremity venous system should do is when there's a pressure coming from above or gravity pushing blood in the wrong direction the valve should close and there should be no flow thereafter that's a normal examination please feel free to call us at 307-232-5054 and schedule your consultation remember we'll walk with you until your legs are healthy again