vein mapping
TRANSCRIPT
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Vein Mapping At re*be
How and why we do it.
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Purpose
• Vein Mapping is done on people with more serious vein problems.
• It is done to identify the anatomy and the physiology of a problem in the venous system.
• It is most critically important to plan the EVLA procedure.
• It is a significant document for the insurance companies so we can get paid. $$$$$
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The Vein Map Form
Name: Date:
Dr. Ronald J. Kolegraff M.D. The re*be Vein Clinic P.O. Box 125 1008 East View Ave Unit 8 Okoboji, Iowa 51355 www.rebeyou.com (712) 332-6001 (712) 332-6010 fax
Right
Left
Socks _______ _______ _______ _______ Left
Socks _______ _______ _______ _______ Right
Deep Veins Compress Flow Clot Yes No Img Yes No Img Yes No Img CFV FV POP
Notes:
GSV = Greater Saphenous Vein AAGSV = Anterior Accessory GSV PAGSV = Posterior Accessory GSV SAGSV = Superficial Accessory GSV PTCV = Posterior Thigh Circumflex Vein ATCV = Anterior Thigh Circumflex Vein SSV = Small Saphenous Vein CESSV = Cranial Extension of the SSV CFV = Common Femoral Vein FV = Femoral Vein PFV = Profunda Femorus Vein POP = Popliteal Vein = Tributary away from Dr T = Tributary toward Dr < = Valve O = Perforator A = Access Point
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The Form is going to change
• As we learn more and need to record more and our documentation, ultrasound, and planning skills improve, this form will change.
• Fill it out with pencil for now. We may need to make changes later to the map.
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Acceptable Names for Veins
• The names of veins is not stable.
• Many clinics use different names than we do.
• We do it right
• These are the vein names we will use.
• Others may be added as the form changes.
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Some naming rules
• Accessory veins start on and then rejoin the vein they are named after. - The anterior accessory GSV leaves the Greater
Saphenous Vein and then travels anterior to it rejoining it somewhere else.
• A tributary is a branch we don’t know where it goes yet or it just ends in very small ‘normal’ veins.
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More Rules
• A perforator dives deep into the leg.– These are good things usually.– They connect the superficial system with the deep
system.– They can become diseased and reflux. – If they do treatment can be indicated.
• A valve is marked when they are located.– Broken valves are usually the reason reflux occurs.
• Access points are marked to plan where to get into a vein during the EVLA procedure.
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The legend for the mapping Symbols
• Symbols• These go in the
symbol box.
There are 4 of these boxes on the form.
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There are two types of Vein Maps
• The anatomic map– This just a drawing where the veins are and
where they branch from their major source veins.
• The hemodynamic map– This is a drawing showing flow of blood.– Only the abnormal areas are marked– It goes on top of the anatomic map like an
overlay.
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The Mapping Process
• Deep System Exam– Checking for clots with compression and flow
studies
• Superficial Venous Exam– Creating a road map and checking for reflux
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The Deep Venous system
• These veins need to be present and working properly as they will take the blood flow if and when the superficial system is treated with EVLA or Sclerotherapy.
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Veins of the Deep System are Checked For
• Compression
• Flow
• Clot
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Compression
• The Ultrasound probe is pushed against the skin watching the vein walls.
• If compression is normal the vessel will close and not be very visible at all on the ultrasound screen
• Letting up the compression allows the vein to fill again.
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Flow
• Color Doppler Ultrasound allows flow to be checked.
• Red means flow away from the heart.
• Blue means flow toward the heart.
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Clot
• If there is a clot in a vein it will not compress completely.
• There will not be any flow in the area of the clot.
• Flow can occur around the clot.
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Evaluation Points
• Common Femoral Vein
• Femoral Vein
• Popliteal Vein
• Smaller calf veins
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Documentation
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Check the boxes
• Img refers to an image being saved on the ultrasound for this exam.
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Superficial Venous Exam
• Fast Survey the GSV (or the SSV)– Using the ultrasound move from ankle to Groin to be
sure there are no surprises (like someone took the vein out)
– No map marks at this point.
• Slow survey this time place pencil cross marks on the vein drawing where something is found.– Fill the symbol box with the appropriate symbol.
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Mapping Process Continued
• Map the tributaries.– Follow them from the vein they branch from and see
where they go.
– This completes the anatomic map
• Do the hemodynamic flow studies to see what refluxes and where on the map the reflux occurs. – Mark the anatomic map with the reflux symbols to
show which areas are diseased.
– (we do not yet have a symbol to mark the reflux)