Bill et all,
I have a question.  I've had a couple pts recently with superficial thrombosis extending into a perforator (beneath the facia) but not into a tibial vein.  I say this is DVT, my medical director does not think so.  Who is right?
Thank you

Carol Wise, RN, RVT, RDCS
Technical Director, Vascular Laboratory
________________________________
From: UVM Flownet [[log in to unmask]] on behalf of Bill Schroedter [[log in to unmask]]
Sent: Monday, December 06, 2010 10:52 AM
To: [log in to unmask]
Subject: Re: anatomic variation in the deep calf veins

Sorry, did not mention the venous anatomy which can kind of be all over the place. Veins are what we call variably variable and this is certainly the case in the calf, especially with arterial variants.

Bill

________________________________
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Norma Vandenberghe
Sent: Friday, December 03, 2010 6:09 PM
To: [log in to unmask]
Subject: Re: anatomic variation in the deep calf veins

Thank you!!! I thought I was alone on a strange planet!! Welcome aboard!


NormaV-

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Craig Hume
Sent: Friday, December 03, 2010 3:01 PM
To: [log in to unmask]
Subject: Re: anatomic variation in the deep calf veins

Seen it yes. Seen a reference. No.
In arterial studies I get cross because the angiogram is always reported as a proximal/mid PTA occlusion despite me showing them the absence of PT vessels at that level on the US screen (usually with me dragging them by the ear).
On Sat, Dec 4, 2010 at 9:38 AM, Norma Vandenberghe <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Has anyone out there in flownetland ever seen a venous anatomy variant that I run across from time to time?
The anatomy starts out normal at the posterior tibial veins at the ankle but just above the ankle both the artery and the veins dive to peroneal depth. I think that there is sometimes a small peroneal branch coming from the foot but I do not always see this. The single PTV/PerVs then course through the calf (with the accompanying PTA/perA) and there is only the one artery from the tibio-peroneal trunk and the one pair of veins joining the venous trunk or popliteal veins. I have seen this maybe 5-6 times a year for probably 15 years now but have never found a description of it in anatomy variant references. When I have done both legs for the study this variant is always (usually?) unilateral with the normal posterior tibial and peroneal vessels on the contralateral leg.
I had a patient like this yesterday; she had a calf vein deep vein thrombosis that had been identified at another lab and was described as being in both the peroneal and the posterior tibial veins, but search as I might I could not see a second artery or a second pair of veins. I usually don’t mention the variant in the report but this one seems more important since the previous study (3 days ago) called it in both veins. What I saw was a prominent mid calf occlusive deep vein thrombosis (a single dilated vein without flow) and the other lab reported non-occlusive deep vein thrombosis in the left peroneal and posterior tibial veins.
Anybody???


NormaV-


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