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Lower Extremity Venous Protocol

Scan through and verify patent venous system before augmenting


Structure

External Iliac
Vein

Common
Femoral &
Great
Saphenous Vein
Junction

Femoral Vein
Central & Deep
Femoral Vein
(aka Profunda
Femoris Vein)

Scan Plane
Transverse
Dual Screen
Sagittal

Transverse
Dual Screen

Label
Identify RT or LT
EIV
W/COMP
EIV
EIV W/AUG
CFV/GSV
W/COMP

Sagittal

CFV/GSV
CFV W/AUG
GSV W/AUG

Transverse
Dual Screen

FV CENTRAL/DFV
W/COMP

Sagittal

FV CENTRAL/DFV
FV W/AUG
DFV W/AUG

Femoral Vein
Mid
Femoral Vein
Peripheral
*Hunters Canal

Popliteal Vein

Posterior Tibial
Veins
Peroneal Veins

Transverse
Dual Screen
Sagittal

FV MID
W/COMP
FV MID
FV MID W/AUG

Transverse
Dual Screen
Sagittal

FV PERIPH
W/COMP
FV PERIPH
FV PERIPH W/AUG

Transverse
Dual Screen
Sagittal

POP V
W/COMP
POP V
POP V W/AUG

Transverse
Dual Screen
Sagittal

PTV
W/COMP
PTV
PTV W/AUG

Transverse
Dual Screen
Sagittal

PERONEAL V
W/COMP
PERONEAL V

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Images Stored
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with
augmentation
Gray Scale CFV & GSV- without
compression
Gray Scale CFV & GSV-with
compression
Color Doppler CFV & GSV
CFV-Color & Spectral Doppler with
augmentation
GSV-Color & Spectral Doppler with
augmentation
Gray Scale FV Central & DFV- without
compression
Gray Scale FV Central & DFV-with
compression
Color Doppler FV Central & DFV
FV Central-Color & Spectral Doppler
with augmentation
DFV-Color & Spectral Doppler with
augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with
augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with
augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with
augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler
Color & Spectral Doppler with
augmentation
Gray Scale- without compression
Gray Scale-with compression
Color Doppler

Lower Extremity Venous Protocol


PERONEAL V W/AUG

Color & Spectral Doppler with


augmentation

Anatomy/Image Correlation

Artery

Vein

Artery

Vein with
Compressi
on

Vein with Spectral


Doppler

Tips
When referring to the venous system, the term central means closer to the heart
(proximal on the leg), and the term peripheral means farther from the heart (more
distal on the leg)
Deep veins always accompany an artery
You should scan the entire leg from groin to ankle in transverse with compression
before storing images.
Only compress veins in the transverse view
Augmentation should not be performed distal to a thrombus/ noncompressible vein
Always scan the symptomatic area (area of pain or palpable mass) in addition to
LEV protocol
Color and Spectral Doppler
Veins should fill completely with color - angle or square box, or use power Doppler if
needed
No angle correct is needed
Gate should be placed in center of vessel
Spectral waveforms should be phasic and augment with distal compression
If proximal (more central) obstruction is suspected, evaluate the contralateral EIV or
CFV for symmetry of spectral waveforms
Thrombus Present
Do not augment peripheral to the location of the thrombus
Document thrombus with color & spectral Doppler
Document exact location of thrombus
Determine if thrombus is occlusive or non-occlusive
Other Pathology Present
Enlarged lymph nodes, fluid collections, or any other masses should be documented
and measured in sagittal and transverse planes, and with color Doppler (spectral if
indicated)
Edema should be documented in gray scale
Incidental finding of significant arterial disease should be documented with gray
scale, color, and spectral Doppler
Duplicated Veins
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Lower Extremity Venous Protocol


May be seen anywhere along the venous system
If above knee, always document both in gray scale, color, and spectral Doppler
Below knee, document both in transverse, and one or both with color Doppler
If thrombus is evident in one or both veins complete documentation is
required
If no evidence of thrombus document only one with spectral Doppler

Labs

D-dimer if increased may indicate thrombus formation

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