E2737. Advanced Venous DOPPLER Imaging
  1. Anne Sailer; Yale School of Medicine
  2. Nadia Solomon; Yale School of Medicine
  3. Shin Mei Chan; Yale School of Medicine
  4. Margarita Revzin; Yale School of Medicine
Deep venous thrombosis or venothromboembolic disease, can lead to pulmonary embolism and post-thrombotic syndrome. Timely diagnosis is imperative for the treatment and prevention of acute and long-term sequelae of deep venous thrombosis. Understanding the diagnosis, evaluation, and imaging characteristics of DVT is important to determine the difference between acute versus chronic thrombus and bland versus tumor thrombus, which affects treatment. Compression enhanced grayscale, color, and Doppler ultrasound is a noninvasive imaging modality used for initial diagnosis. There are various pathologies that can lead to abnormal venous waveforms including external compression, infection, stenosis, cardiac disease, tumor invasion, venous air, varices, abnormal venous communications, or valve insufficiency.

Educational Goals / Teaching Points
Review of venous waveform analysis. Review of advanced Doppler based and non-Doppler-based ultrasonographic technique, including troubleshooting technical issues. Review of variant anatomy and mimics. Case-based review of various venous pathologies and their ultrasonographic manifestations focused on their effect on the normal venous waveforms, and secondary signs consistent with the underlying pathology.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Overview of normal and abnormal venous waveforms, including case-based review of the following causes these abnormal waveforms, external compression (mechanical compression, thoracic outlet syndrome, May-Thurner Syndrome), infection, stenosis, cardiac disease, tumor invasion, venous air, varices, abnormal communication or valve insufficiency. Review of advanced Doppler applications (directional power doppler, SMI, MVI, and MFI for optimization of slow flow), and non-Doppler applications (B-flow, shear wave elastography, compression enhanced ultrasound technique, intravascular ultrasound, and photoacoustic imaging). Variant anatomy and troubleshooting (duplicated veins, hypoplastic veins) and mimics (collaterals, wall calcifications, shunts). Differentiation between slow flow and non-occlusive thrombus, including secondary signs of acute and chronic thrombus.

Venous Doppler US is a powerful tool in noninvasive evaluation of venous system. New methods and Doppler US-based applications have emerged that will aid in grading thrombus chronicity and allow more accurate evaluation of degree of venous occlusion and recanalization. Waveform analysis is a window for correct diagnosis of pathology and should be always used to avoid mistakes in diagnosis.