Vein Mapping At re*be

How and why we do it.

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. $$$$$

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

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.

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.

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.

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.

The legend for the mapping Symbols

• Symbols• These go in the

symbol box.

There are 4 of these boxes on the form.

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.

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

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.

Veins of the Deep System are Checked For

• Compression

• Flow

• Clot

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.

Flow

• Color Doppler Ultrasound allows flow to be checked.

• Red means flow away from the heart.

• Blue means flow toward the heart.

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.

Evaluation Points

• Common Femoral Vein

• Femoral Vein

• Popliteal Vein

• Smaller calf veins

Documentation

Check the boxes

• Img refers to an image being saved on the ultrasound for this exam.

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.

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)