Venous valve assessment in obvious varicose veins is really a no-brainer but early superficial and deep venous disease is trickier.  I have always been taught that venous valves are designed to operate correctly in a physiological state, i.e. standing.  Studies using B-flow show exactly how blood flow dynamics in and around the valve cusps in addition to simultaneous changes in the shape and size of the vein and valve ring (dumbbell to ovoid) creates competence.   Anything less than standing will affect this as valve architecture symmetry and subsequently function relies on gravity and blood travelling through the valve at a certain velocity for everything to fall into place so to speak – if the vein is not fully distended the valve cusps do not stretch the required amount and take on a concertina appearance along the line of apposition much like a clam shell.  This is more obvious in patients with early to moderate disease where you’re likely to get a false positive as blood squeezes through this irregular area.  I have had several arguments with phlebologists in particular who show me “reflux” in a 3 or 4 mm straight GSV to satisfy the criteria for EVLA and justify treatment. 

 

Michael

 

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Steve Knight
Sent: Thursday, 10 February 2011 7:23 AM
To: [log in to unmask]
Subject: Re: Venous Reflux and ICAVL requirements

 

OK folks. The sandbox is closed.  Move along.

On Wed, Feb 9, 2011 at 3:13 PM, Nancy Williams <[log in to unmask]> wrote:

:o Peace!
I have no desire to be email buddies with you but it would have been
nice if you had actually added something constructive to the ergonomic
conversation, other than criticism of me that is. And if I'm not
mistaken I believe it was my opinion that started this. My opinion being
to work smarter not harder. I'm not sure why this concept is so
provocative. And Miss Kelly I believe you started this one. Although to
be fair I feel sure there is very little we would ever agree upon other
than that we're both tired of this discussion.
Who'd have thought wanting my fellow technologists in the field to be
safe and happy would cause all this? Certainly not me. I swear I'm a
totally normal, rational, happy go lucky type. Never had so much as a
parking ticket. I certainly don't go around cyber threatening strangers.
My sincerest wish for you all to have a lovely day. Sorry this
conversation turned so silly. It started out as a very worth wile
conversation. I'm not sure how it turned into Girls Gone Nutso. Sorry
for that.
:) Peace!


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Estes,
Kelly M

Sent: Wednesday, February 09, 2011 2:23 PM
To: [log in to unmask]
Subject: Re: Venous Reflux and ICAVL requirements

No, its your tone, not that you don't agree with me. Enough.....email me
off site if you feel to continue this.

Kelly Estes



-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Nancy
Williams
Sent: Wednesday, February 09, 2011 2:08 PM
To: [log in to unmask]
Subject: Re: Venous Reflux and ICAVL requirements

Apparently if I don't agree with you I'm rude. O.k.
You're a little late to the party aren't you? I believe this horse is
not only dead but buried. And I believe I used the term snarky not rude
when I apologized the FIRST TIME! But what do I know? My mother taught
me not to call people names. I see yours was not so inclined :) Keep it
coming the horse is showing signs of life...


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Estes,
Kelly M
Sent: Wednesday, February 09, 2011 1:43 PM
To: [log in to unmask]
Subject: Re: Venous Reflux and ICAVL requirements

That was quite rude. Everyone is entitled to their opinion Nancy. We all
get one, not just you.

Kelly Estes


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Nancy
Williams
Sent: Tuesday, February 08, 2011 9:04 PM
To: [log in to unmask]
Subject: Re: Venous Reflux and ICAVL requirements

And again....soooooo, not condemning the use of the $7000.00 table here.
Kudos.
So do not work for Dr. Mengele. I have a very nice table in a very nice
office with very nice doctors who don't make me lay in the floor.
So delighted that everyone but me seems to have 3 hours to do these vein
exams and arrange your accoutrements.
But please, isn't there anyone, just anyone, out there brave enough to
admit they aren't using this wonder table or some other such
contraption? Someone to admit that they just stand their patients at the
side of the bed or use a nice reverse trendelenberg? Someone who has not
been put into an iron lung by career ending injuries? Someone that
manages to go to work and not break their backs or kill their patients
in the process that is willing to share some tips and quite possibly
save a life???? If not I'm pretty sure this horse is dead...God knows I
hope it is...Cuz it needs to be!...Peace!



-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Kelly
Sent: Tuesday, February 08, 2011 8:07 PM
To: [log in to unmask]
Subject: Re: Venous Reflux and ICAVL requirements

I love my multi thousand dollar table! I am very happy that our employer
has
allowed us to purchase three of them and that I work in an environment
that
takes our health into consideration.

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--
Steve Knight BSc RVT RDCS
Specialists In Ultrasound, Inc.

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