DVT ultrasound

Anatomy

1. Significant risk of PE:
   1. Common femoral vein
   2. (Superficial) femoral vein
      1. (Superficial) femoral vein is part of the deep system, not the superficial system as the name suggests!
   3. Popliteal veins

Technique

1. Patient positioning
   1. Reverse trendelenberg or semi-sitting with 30 degrees of hip flexion
   2. Mild external rotation (30 degrees) hip
2. Transducer
   1. Linear array vascular probe 6–10 MHz
   2. 6–8cm width ideal (for larger patients, consider abdominal probe)
3. Compression
   1. Compress vein with transducer (probe transverse to vein)
   2. Touching of anterior and posterior walls = normal
   3. No touching with pressures sufficient to deform the artery = likely DVT
4. Common Femoral Vein
   1. 10cm distal to the inguinal crease
   2. Apply compression every centimeter
   3. Continue distal to 1-2cm beyond bifurcation of the common femoral vein (into superficial and deep branches)
5. Popliteal vein
   1. Prone, decubitus position, or seated on edge of gurney
   2. Knee flexed 10–30 degree
   3. Reverse trendelenberg
   4. 12 centimeters superior, to 5 centimeters inferior to the popliteal crease
      1. Vein usually superficial to artery