Pop Quiz: What do Chicago (and the Northern Suburbs) have in common with Antarctica? If you can’t answer the question then you are likely reading this on the veranda of your winter refuge someplace far away and warm. Yes, I still have sympathy for you and your vein issues…but perhaps just a bit less than those who are slugging it out here with me in that frozen wasteland we call Chicagoland.
Diagnosis: The Ultrasound Don’t freak-out…this is not going to be an in-depth, headache-provoking foray into the vagaries of ultrasound physics. [whew!] Simply put, an ultrasound probe puts out sound waves that either pass through or bump into things. Think of a submarine under water or a radar above ground…sending out signals with a transmitter and then picking up the signals that return with a receiver. It turns out that the same probe that generates the sound waves also picks up the returning signals and then sends the info to a computer (nowadays the size of a laptop…probably before we know it the size of a postage stamp given the rapidity at which technology advances) and this computer puts the information together as a picture that physicians can interpret. Not only can we tell the size and location of veins, but also how they function…including, no ESPECIALLY, valve function. Best of all, it’s completely non-invasive and painless. The only thing you have to put up with is the gooey gel that ultrasonographers must use to help obtain the highest quality images. Women are used to this from their obstetric ultrasounds. Men…it’s high time you joined the party! Bring on the goo! What do we look for? 1) Anatomy: Every patient is unique, but we can typically spot the major players of the Deep & Superficial Venous Systems as well as any obvious perforators. (See Vein Anatomy Lecture for a refresher). 2) Pathology/Pathophysiology: a)Size: abnormal if -GSV>3mm -SSV>2mm -Perforators>4mm …again, size is not really as big a deal as whether or not the valves function properly and only allow one-way, upward flow rather than… b)Incompetence: Reflux By squeezing the area of the extremity below the vein we are investigating, we simulate what the “muscle pump” ordinarily does when we walk around and we send a jet of blood going up the vein past the valves in question. The ultrasound machine helps us detect if blood is trickling back down the leg (suggesting an incompetent valve) and for how long the trickle lasts. The backwards, wrong way flow is considered abnormal if the […]