The American College of Surgeons has assigned a maximum of 14 AMA PRA Category 1 Credits™ to the course. Self-assessment credit has been assigned for the entire course. The post-test must be completed by September 18, 2014. A minimum performance level of 75% must be attained in order to earn the self-assessment credit. Multiple attempts are permitted within the 10-day span. Please note that a physician cannot earn the entire self-assessment credit if he/she has not attended the entire course. CME ScaleSeptember 5Morning Sessions: 3. 5 credit hoursAfternoon Sessions: 3. 5 credit hoursSeptember 6Morning Sessions: 4 credit hoursAfternoon Sessions: 3 credit hours
Anterior accessory and great saphenous veins.
Perforator and great saphenous veins.
Great saphenous and small saphenous veins.
Small saphenous and superficial femoral veins.
All perforators should be ablated
Only C5 and C6 should have perforator surgery once the superficial reflux has been corrected
Perforator diameter of less than 3.5 mm with reflux should be ablated
Symptomatic C2 and C3 patients with perforator insufficiency should have ablation in conjunction with superficial saphenous ablation
Scattered, dissipated, absorbed
Reflected, diminished, intensified
Attenuated, scattered, reflected
Absorbed, reflected, scattered
Phasic flow in the common femoral vein
Chronic changes in the common femoral vein
Pulsatility in the common femoral vein
Continous non-phasic flow in the common femoral vein
3.0% Sodium Tetradecyl Sulfate (STS) liquid
0.5% Polidocanol (PD) liquid
Foam sclerotherapy
1.0% Polidocanol (PD)
Randomized patients with DVT +/- PE to receive or not receive an IVC filter in addition to anticoagulation and the follow up was 18 years.
At 8 years patients with IVC filters had a significant decrease in pulmonary embolism
At 18 years there was an increase in survival in patients receiving IVC filters
At 8 years patients with an IVC filter had significantly less recurrent deep vein thrombosis
Rarely contributes to the development of chronic venous insufficiency
Is only caused by venous thrombosis
May be diagnosed using venography or IVUS
Can often by treated by stenting and data supports this approach.
In the presence of LEFT ovarian vein reflux, varicose veins always appear on the LEFT labial and leg region
If pelvic venous congestion is associated with severe obstruction of the left renal vein or iliac veins, then this obstruction should be treated prior to pelvic venous embolization when possible
Pelvic Venous Congestion Syndrome is a disorder common in post menopausal women
If internal iliac vein reflux is detected, coils should always be used along with catheter directed sclerotherapy
Angiogram
Venogram
CT scan
MRI
Duplex ultrasound
45 year old with femoropopliteal DVT less than 14 days in duration.
55 year old with iliofemoral DVT of less than 14 days in duration.
55 year old with femoropopliteal DVT of less than 21 days in duration.
45 year old with iliofemoral DVT of less than 21 days in duration.
Continued high strength compression bandaging
High ligation and stripping of the great saphenous vein
Endovenous laser ablation of the great saphenous vein
Application of Apligraf to the wound and continued high strength compression bandaging.
On chronic therapeutic anticoagulation
After a provoked acute DVT that resolves on anticoagulation
After thrombolysis for acute DVT while on therapeutic rivaroxaban (xarelto)
With diffuse chronic scar in the iliac and common femoral veins.
Unfractionated heparin
Low molecular weigh heparin
Fondaprinux
Warfarin
Diameter of existing varicosities
Number of visible varicose veins
Time to ulcer healing
Rate of new varicosity formation
The morbidly obese
Those with previous DVT
Women
Those with arterial insufficiency
Treatment of the incompetent perforator veins
Treatment of the incompetent perforator veins, even if the above patient had extensive history of ileofemoral deep vein thrombosis
Treatment of incompetent perforator veins even if the patient had only edema and varicose veins (C3) and no leg ulcers.
Treatment of the incompetent perforator veins even if the patient had deep venous reflux in femoral and popliteal veins, GSV reflux, and subacute calf vein DVTs.
Anterior Accessory Saphenous Vein
Vein of Giacommini
Posterior Saphenous Vein
Vein of Stephens
‘A’ mode
'B’ mode
'M’ mode
‘D’ mode
Infrared and Doppler
Doppler and ‘B’ mode
'A’ mode and ‘B’ mode
Doppler and ‘M’ mode
In the thigh
In the calf
Never
Only in the left leg
Is duplicated
Is less than 3 mm in diameter
Is within the saphenous fascia
Is right beneath the skin
Is often duplicated
Is deep to the fascia in the upper calf
Always enters the popliteal vein at the popliteal crease
Is always medial to the Achille’s tendon
Always lies within the saphenous fascia
Can exit the fascia
Is always singular
Is > 3 mm in patients with varicose veins
Always contributes to varicose veins
Can be normal with varicose veins
Has at least 10 valves
Is correctly called the Long Saphenous Vein
Wait!
Here's an interesting quiz for you.