Bill Johnson, Port Townsend, WA
Connie and Terry,
I would add a comment regarding proximal compressions. While it is standard practice to perform exams in reverse Trendelenberg, the intralumenal hydrostatic pressure is still less than in a standing position. Venous distention due to hydrostatic pressure can cause valvular incompetence, and proximal compressions may demonstrate this while distal compressions will probably not. This is why many protocols for evaluation of venous insufficiency include evaluation of some segments, usually the common femoral and popliteal, in a standing position.
Terry's point about "brisk" response to augmentation is well taken. While it is subjective, it was an important criterion in the days before duplex, still is for some of us. And, yes, there were venous Doppler exams before imaging, ask a dinosaur.
BTW the only "silly" question is the one unasked.
From: UVM Flownet on behalf of Terry Zwakenberg
Sent: Fri 1/8/2010 3:41 PM
To: [log in to unmask]
Subject: Re: silly venous question
we traditionally use the proximal compression for 2 reasons. first is to note reflux with compression, second is the siphon effect, I have many times had to rely on doppler signals when unable to visualize the entire adductor canal in dvt studies. a good siphon and brisk augmentation from both sides can help clear difficult to image segments.
To handle yourself, use your head. To handle others, use your heart.
On Fri, Jan 8, 2010 at 3:39 PM, Connie McCoy <[log in to unmask]> wrote:
If distal augmentation while performing a venous duplex exam evaluates for valvular competency; what is the purpose of proximal augmentation?
Your thoughts/comments are appreciated.
Connie McCoy, RVT
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