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July 2010

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From:
Don Ridgway <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Date:
Fri, 9 Jul 2010 10:44:38 -0700
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What would the Valsalva maneuver have to do with decreased CFV venous flow? Reduced spontaneous flow compared to the other side is certainly cause for suspicion, but I don't see Valsalva adding to that information. Seems to me there could be a risk of dislodging iliac thrombus with an energetic Valsalva. That's a tool for reflux testing, not DVT.

Don Ridgway






-----Original Message-----
From: UVM Flownet on behalf of JASON r
Sent: Fri 7/9/2010 10:40 AM
To: [log in to unmask]
Subject: Re: DVT study with Valsalva
 

I agree too an extent. 

 

Since we have our own cath lab and perform may venograms based on decreased venou signal in the CFV, and can say matter of factly >88% of the time there is a proximal thrombus. 

 

J
 


Date: Fri, 9 Jul 2010 07:12:58 -0700
From: [log in to unmask]
Subject: Re: DVT study with Valsalva
To: [log in to unmask]





Studies over the years have shown that Deep Venous reflux done with valsalva while the patient is supine/obesity 
has many false positive results. There are many variables, the easiest to see is the PW gate placement in relation to 
the deep valve at the groin and the pop fossa. Since there has been shown to be less deep valves in the area above the 
groin than below, it would follow that the valves below the groin can be competent even with prev DVT in the iliac system. 
Pelvic congestion syndrome, I believe, is an example of incompetence in deep system of the abdomen and yet the 
area below the groin can remain symptom free in some people.
I am not going to do a Valsalva on every person that is coming in to be evaluated for DVT. I investigate areas of concern
by whatever means I have to give the best information to the MD I can. Most people come in for a concern for DVT, few
have other symptoms that warrant areas of the abdomen,ect. I have not seen a valsalva give me a clue to prx obstruction- a decrease augmentation-yes, history of prev abd surgery-yes. I take pics of lymph tissue with my power angio to show if there is vascularization, many of many patients have gone on to be diagnosed with lymphoma. Why-unexplained leg swelling.
The Reflux exam is a separate exam than the "DVT" study. I also do not do the Reflux exam unless the person has been evaluated by a specialist and has decided to go on to treatment if need be. 
Lisa
 


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