{"id":280,"date":"2018-07-01t12:00:03","date_gmt":"2018-07-01t02:00:03","guid":{"rendered":"\/\/www.iolishoes.com\/?page_id=280"},"modified":"2021-08-19t12:10:20","modified_gmt":"2021-08-19t02:10:20","slug":"venous-incompetence","status":"publish","type":"page","link":"\/\/www.iolishoes.com\/venous-incompetence\/","title":{"rendered":"venous incompetence"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"280\" class=\"elementor elementor-280\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5a1a579 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5a1a579\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8d05cc7\" data-id=\"8d05cc7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-417153cf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"417153cf\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7d18873e\" data-id=\"7d18873e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7814ac35 elementor-widget elementor-widget-heading\" data-id=\"7814ac35\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\"><span class=\"ez-toc-section\" id=\"flow_dynamics\"><\/span>flow dynamics<span class=\"ez-toc-section-end\"><\/span><\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-61b7b6c8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"61b7b6c8\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3e223f63\" data-id=\"3e223f63\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6b60cc67 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"6b60cc67\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e584630 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e584630\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-17201b52\" data-id=\"17201b52\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3a8135e9 elementor-flip-box--effect-fade elementor-widget elementor-widget-flip-box\" data-id=\"3a8135e9\" data-element_type=\"widget\" data-widget_type=\"flip-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-flip-box\" tabindex=\"0\">\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__front\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__back\">\n\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-28e19f8f elementor-widget elementor-widget-text-editor\" data-id=\"28e19f8f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>normal venous flow and valve movement,<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-43b682d4\" data-id=\"43b682d4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fea6133 elementor-widget elementor-widget-text-editor\" data-id=\"fea6133\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00a0<\/p><p>\u00a0<\/p><p>normal flow<\/p><p>in the normal cicumstance, the superficial system drains the subcutaneous tissues and periodically empties into the deep system via perforating veins.<\/p><p>flow direction should always be:<\/p><ul><li>cephalad.<\/li><li>superficial to deep.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3ea2832 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3ea2832\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-3a62cbf5\" data-id=\"3a62cbf5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4f9e1f63 elementor-flip-box--effect-fade elementor-widget elementor-widget-flip-box\" data-id=\"4f9e1f63\" data-element_type=\"widget\" data-widget_type=\"flip-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-flip-box\" tabindex=\"0\">\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__front\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__back\">\n\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-730574d elementor-widget elementor-widget-text-editor\" data-id=\"730574d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>incompetent valve &amp; perforator leading to venous reflux.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4c56cbe9\" data-id=\"4c56cbe9\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fbc8666 elementor-widget elementor-widget-text-editor\" data-id=\"fbc8666\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00a0<\/p><p>\u00a0<\/p><p>incompetent flow<\/p><p>with distal augmentation, flow initially goes cephalad. it then refluxes back down the leg through the malfunctioning valve.<\/p><p>an incompetent perforating vein also allows blood to flow from the deep veins to the surface veins.<\/p><p>this combination of back pressure causes dilation and tortuosity of the veins (ie varicosites).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6523e7f0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6523e7f0\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-41bbe05\" data-id=\"41bbe05\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-40f045bc elementor-widget elementor-widget-heading\" data-id=\"40f045bc\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\"><span class=\"ez-toc-section\" id=\"normal_vein_valve\"><\/span>normal vein valve<span class=\"ez-toc-section-end\"><\/span><\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7e9e90eb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7e9e90eb\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-32467e4a\" data-id=\"32467e4a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7869cbdd\" data-id=\"7869cbdd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-61e4981d elementor-flip-box--effect-fade elementor-widget elementor-widget-flip-box\" data-id=\"61e4981d\" data-element_type=\"widget\" data-widget_type=\"flip-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-flip-box\" tabindex=\"0\">\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__front\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__back\">\n\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-218adcc6 elementor-widget elementor-widget-text-editor\" data-id=\"218adcc6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>normal venous valve.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ab6c671 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ab6c671\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b493e6f\" data-id=\"b493e6f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0ce65a2 elementor-grid-2 elementor-grid-tablet-2 elementor-grid-mobile-1 pp-video-gallery-content-below-video pp-swiper-slider-pagination-outside elementor-widget elementor-widget-pp-video-gallery\" data-id=\"0ce65a2\" data-element_type=\"widget\" data-settings=\"{&quot;layout&quot;:&quot;carousel&quot;,&quot;pause_on_hover&quot;:&quot;yes&quot;}\" data-widget_type=\"pp-video-gallery.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"pp-video-gallery-container pp-video-gallery-carousel\">\n\t\t\t<div class=\"pp-video-gallery-wrap swiper-container-wrap\">\n\t\t\t\t\t\t\t\t<div class=\"pp-video-gallery pp-swiper-slider swiper\" data-action=\"lightbox\" data-slider-settings=\"{&quot;speed&quot;:500,&quot;slides_per_view&quot;:2,&quot;slides_to_scroll&quot;:1,&quot;space_between&quot;:20,&quot;auto_height&quot;:&quot;yes&quot;,&quot;loop&quot;:&quot;yes&quot;,&quot;autoplay&quot;:&quot;yes&quot;,&quot;autoplay_speed&quot;:999999,&quot;pagination&quot;:&quot;bullets&quot;,&quot;show_arrows&quot;:true,&quot;slides_per_view_mobile&quot;:1,&quot;space_between_mobile&quot;:10,&quot;slides_per_view_tablet&quot;:2,&quot;space_between_tablet&quot;:10}\" dir=\"ltr\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-slide\">\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-container\">\n\t\t\t\t\t\t\t<div class=\"pp-video-play\" data-fancybox=\"video-gallery-0ce65a2\" href=\"https:\/\/vimeo.com\/568004039\">\n\t\t\t\t\t\t\t\t<div class=\"pp-media-overlay pp-video-overlay\"><\/div>\t\t\t\t\t\t\t\t<div class=\"pp-video-player\">\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" class=\"pp-video-thumb\" src=\"https:\/\/i.vimeocdn.com\/video\/1174563860-f5e16455b9d9deb510c980bbb60fe4188d7692e1047e4df80c405054134f54a8-d_840\" alt=\"\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"pp-video-play-icon pp-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-play-circle\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"pp-video-content-container\">\n\t\t\t\t<div class=\"pp-video-content\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-title\">\n\t\t\t\t\t\t\tultrasound of a competent vein valve\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-description\">\n\t\t\t\t\t\t\tnormal competent venous valve as seen on b mode ultrasound.\nit is important not to mistake this for thrombus.\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\">\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-container\">\n\t\t\t\t\t\t\t<div class=\"pp-video-play\" data-fancybox=\"video-gallery-0ce65a2\" href=\"https:\/\/vimeo.com\/568004022\">\n\t\t\t\t\t\t\t\t<div class=\"pp-media-overlay pp-video-overlay\"><\/div>\t\t\t\t\t\t\t\t<div class=\"pp-video-player\">\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" class=\"pp-video-thumb\" src=\"https:\/\/i.vimeocdn.com\/video\/1174580089-c4e58a9b7b44e9f15a97988b9df54da7769b46447a53f919b4cd016363364c87-d_840\" alt=\"\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"pp-video-play-icon pp-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-play-circle\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"pp-video-content-container\">\n\t\t\t\t<div class=\"pp-video-content\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-title\">\n\t\t\t\t\t\t\tultrasound of a competent valve transverse view\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-description\">\n\t\t\t\t\t\t\tthe 2 valve leaflets can be seen meeting in this transverse cross-sectional ultrasound view of the vein. this represents a competent valve however doppler assessment would be required to confirm this.\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\">\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-container\">\n\t\t\t\t\t\t\t<div class=\"pp-video-play\" data-fancybox=\"video-gallery-0ce65a2\" href=\"https:\/\/vimeo.com\/568010083\">\n\t\t\t\t\t\t\t\t<div class=\"pp-media-overlay pp-video-overlay\"><\/div>\t\t\t\t\t\t\t\t<div class=\"pp-video-player\">\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" class=\"pp-video-thumb\" src=\"https:\/\/i.vimeocdn.com\/video\/1174583793-4b080f2fb9c5678aa8d6cb59ce5b5b7e7e0c8a7d9c425f48be0a324665029a04-d_840\" alt=\"\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"pp-video-play-icon pp-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-play-circle\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"pp-video-content-container\">\n\t\t\t\t<div class=\"pp-video-content\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-title\">\n\t\t\t\t\t\t\tincompetent vein b mode ultrasound\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-description\">\n\t\t\t\t\t\t\tthis swirling slow moving blood is typically seen in veins when using high frequency ultrasound. colour doppler is unlikely to demonstrate flow due to the very slow velocity not creating a doppler shift within the range of the probe. the to-fro nature of the flow indicates incompetence.\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\">\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-container\">\n\t\t\t\t\t\t\t<div class=\"pp-video-play\" data-fancybox=\"video-gallery-0ce65a2\" href=\"https:\/\/vimeo.com\/568004051\">\n\t\t\t\t\t\t\t\t<div class=\"pp-media-overlay pp-video-overlay\"><\/div>\t\t\t\t\t\t\t\t<div class=\"pp-video-player\">\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" class=\"pp-video-thumb\" src=\"https:\/\/i.vimeocdn.com\/video\/1174567013-7a657daac261d7720feaba8ba932a5c7aa68ad6d3e83e96cbac1735200fd6303-d_840\" alt=\"\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"pp-video-play-icon pp-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-play-circle\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"pp-video-content-container\">\n\t\t\t\t<div class=\"pp-video-content\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-title\">\n\t\t\t\t\t\t\tultrasound mobile superficial thrombosis\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-description\">\n\t\t\t\t\t\t\tsuperficial thrombophlebitis on ultrasound. the non-occlusive mobile thrombus is visible inside the vein. there is increase echogenicity of the subcutaneous fat surrounding the vein consistant with fovcal inflammation (phlebitis).\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\">\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-container\">\n\t\t\t\t\t\t\t<div class=\"pp-video-play\" data-fancybox=\"video-gallery-0ce65a2\" href=\"https:\/\/vimeo.com\/568004000\">\n\t\t\t\t\t\t\t\t<div class=\"pp-media-overlay pp-video-overlay\"><\/div>\t\t\t\t\t\t\t\t<div class=\"pp-video-player\">\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" class=\"pp-video-thumb\" src=\"https:\/\/i.vimeocdn.com\/video\/1174564203-e8cdfef83cfc331b8960db699e27c30540a210ef2192c6c379b9beb5210be6d8-d_840\" alt=\"\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"pp-video-play-icon pp-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-play-circle\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"pp-video-content-container\">\n\t\t\t\t<div class=\"pp-video-content\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-title\">\n\t\t\t\t\t\t\tultrasound mobile superficial thrombo-phlebitis\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pp-video-description\">\n\t\t\t\t\t\t\tsuperficial thrombophlebitis ultrasound\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<!-- add pagination -->\n\t\t\t<div class=\"swiper-pagination swiper-pagination-0ce65a2\"><\/div>\n\t\t\t\t\t\t\t<div class=\"pp-slider-arrow elementor-swiper-button-prev swiper-button-prev-0ce65a2\" role=\"button\" tabindex=\"0\">\n\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-angle-left\"><\/i>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"pp-slider-arrow elementor-swiper-button-next swiper-button-next-0ce65a2\" role=\"button\" tabindex=\"0\">\n\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-angle-right\"><\/i>\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d87a1e2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d87a1e2\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e0bc975\" data-id=\"e0bc975\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-295bf42 elementor-widget elementor-widget-text-editor\" data-id=\"295bf42\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\"><span style=\"font-size: 24pt;\"><strong>leg vein anatomy<\/strong><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1135277f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1135277f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-63e2f682\" data-id=\"63e2f682\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6b0a7fb2 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"6b0a7fb2\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-641e4aa8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"641e4aa8\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7826d58d\" data-id=\"7826d58d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-77d1e671 elementor-widget elementor-widget-heading\" data-id=\"77d1e671\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\"><span class=\"ez-toc-section\" id=\"nomenclature\"><\/span>nomenclature<span class=\"ez-toc-section-end\"><\/span><\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-74b68450 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"74b68450\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-637e0658\" data-id=\"637e0658\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-73828404 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"73828404\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm elementor-animation-grow\" href=\"\/\/www.iolishoes.com\/wp-content\/uploads\/2021\/06\/vein-nomenclature.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-arrow-alt-circle-down\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">click here<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-500976ee\" data-id=\"500976ee\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-73f54fdf elementor-widget elementor-widget-text-editor\" data-id=\"73f54fdf\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><a href=\"\/\/www.iolishoes.com\/wp-content\/uploads\/2021\/06\/vein-nomenclature.pdf\"><strong>for a comprehensive document on the international consensus of leg vein labelling.<\/strong><\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-331a52c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"331a52c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d124473\" data-id=\"d124473\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-db5c087 elementor-widget elementor-widget-text-editor\" data-id=\"db5c087\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>ref: journal of vascular surgery, special communication, 2005. (215kb pdf file)<\/p><p>we recommend reviewing this thorough document.<\/p><p>importantly, to avoid confusion, the &#8216;long saphenous&#8217; is now the &#8216;great saphenous&#8217;.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-844ce4b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"844ce4b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3a30b810\" data-id=\"3a30b810\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3e8451eb elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"3e8451eb\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-113c8752 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"113c8752\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-61f094e3\" data-id=\"61f094e3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-272c4016 elementor-widget elementor-widget-heading\" data-id=\"272c4016\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\"><span class=\"ez-toc-section\" id=\"what_are_varicose_veins\"><\/span>what are varicose veins<span class=\"ez-toc-section-end\"><\/span><\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7223094 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7223094\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b334eb5\" data-id=\"b334eb5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4534690 elementor-widget elementor-widget-text-editor\" data-id=\"4534690\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>below is a basic outline of the anatomy and function of the veins and what constitutes venous incompetence. be aware however that there are numerous anatomical variations.<\/p><p><strong>valves<\/strong><\/p><p>the veins contain a series of valves along their course, preventing retrograde flow back down the leg. these valves operate like two plastic doors opening up the leg. if back pressure is applied, they swing closed, pushing against each other, blocking reverse flow down the leg.<br \/>if functioning normally, it is a competent valve. if blood is able to pass backwards though the valve, it is deemed incompetent.<br \/>depending on the extent of incompetence, this backflow will dilate the supple superficial veins making them tortuous and dilated(varicose veins).<br \/><strong>causes include<\/strong>:<\/p><p>familial factors with &#8216;lax&#8217; veins. these distend slightly allowing the valve leaflets to no longer oppose each other.<br \/>injury or thrombosis. both of these can lead to adherance of valve leaflets to the vein wall, rendering the valve useless.<br \/><strong>the deep veins<\/strong><\/p><p>are the primary route for returning blood to the heart. they collect the venous blood from all the draining muscular and superficial veins.<br \/>in the lower limb the deep veins are: (from groin to ankle)<\/p><ul><li>common femoral vein (cfv)<\/li><li>superficial femoral vein (sfv)- also called just the femoral vein.<\/li><li>popliteal vein (popv)<\/li><li>anterior tibial (atv)<\/li><li>posterior tibial (ptv<\/li><li>peroneal veins (per v)<br \/>the latter 3 are calf veins that generally run in pairs (venous commantantes)<br \/><br \/><\/li><\/ul><p><strong>the superficial veins<\/strong><br \/>there are 2 main superficial veins draining the subcutaneous tissue of the lower leg:<\/p><p>the great saphenous vein (gsv) runs from the medial malleolus, up the medial aspect of the leg, draining into the cfv at the groin as the sapheno-femoral junction (sfj).<br \/>the short saphenous vein (ssv) runs up the posterior midline of the calf. it may drain into the proximal popv above the knee crease as the sapheno-popliteal junction (spj). commonly however, it may continue up the posterior thigh as the giacomini vein. this will terminate either into the mid\/distal sfv or ascend to drain into the proximal lsv.<br \/>incompetence of the sfj and spj are the two primary sources of varicose veins.<\/p><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4b6d73eb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4b6d73eb\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5a7178dd\" data-id=\"5a7178dd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-39f59d07 elementor-widget elementor-widget-heading\" data-id=\"39f59d07\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\"><span class=\"ez-toc-section\" id=\"sapheno-femoral_junction\"><\/span>sapheno-femoral junction<span class=\"ez-toc-section-end\"><\/span><\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-499dc49 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"499dc49\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a712a01\" data-id=\"a712a01\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c1ef945 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"c1ef945\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1d3e4bb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1d3e4bb\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-52d4e33\" data-id=\"52d4e33\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e14a9f5 elementor-widget elementor-widget-text-editor\" data-id=\"e14a9f5\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>the termination of the great saphenous vein (gsv) into the common femoral vein (cfv) in the groin.<\/li><li>is the primary source of venous incompetence and varices of the lower limb.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6755033e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6755033e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-29ac392a\" data-id=\"29ac392a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6227319b elementor-flip-box--effect-fade elementor-widget elementor-widget-flip-box\" data-id=\"6227319b\" data-element_type=\"widget\" data-widget_type=\"flip-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-flip-box\" tabindex=\"0\">\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__front\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__back\">\n\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-74fe36e2 elementor-widget elementor-widget-text-editor\" data-id=\"74fe36e2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>sapheno-femoral junction anatomy<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-14130b2d\" data-id=\"14130b2d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-64ca534 elementor-widget elementor-widget-text-editor\" data-id=\"64ca534\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00a0<\/p><p><strong>sapheno-femoral junction anatomy<\/strong><\/p><p>deep veins<\/p><ul><li>common femoral vein (cfv)<\/li><li>superficial femoral vein (sfv)<\/li><li>proffunda femoris vein (proffv)<\/li><\/ul><p>superficial veins:<\/p><ul><li>long (great) saphenous vein (lsv)<\/li><li>medial accessory saphenous vein (masv)<\/li><li>lateral accessory saphenous vein (lasv)<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-28bcbaf3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"28bcbaf3\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-424d1942\" data-id=\"424d1942\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5ad99e96 elementor-widget elementor-widget-heading\" data-id=\"5ad99e96\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\"><span class=\"ez-toc-section\" id=\"sapheno-popliteal_junction\"><\/span>sapheno-popliteal junction<span class=\"ez-toc-section-end\"><\/span><\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b8dac25 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b8dac25\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6dfa5a4\" data-id=\"6dfa5a4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7516414 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"7516414\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c4c49cf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c4c49cf\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e22744f\" data-id=\"e22744f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3b83ca3 elementor-widget elementor-widget-text-editor\" data-id=\"3b83ca3\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>the termination of the short saphenous vein (ssv) into the popliteal vein (popv) in the popliteal fossa.<\/li><li>the spj is absent in 25% of the population, continuing up the posterior thigh as the giacomini vein.<\/li><li>only 15% of people have a midline spj. the remaining junctions are medial\/lateral, often via a gastrocnemius vein.<br \/>(both ref: &#8220;the vein book&#8221; author: john j. bergan)<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3406b754 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3406b754\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-2296baf5\" data-id=\"2296baf5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6c6998dc elementor-flip-box--effect-fade elementor-widget elementor-widget-flip-box\" data-id=\"6c6998dc\" data-element_type=\"widget\" data-widget_type=\"flip-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-flip-box\" tabindex=\"0\">\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__front\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__back\">\n\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-70384fc0 elementor-widget elementor-widget-text-editor\" data-id=\"70384fc0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>sapheno-popliteal (spj) anatomy diagram.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7e229bb4\" data-id=\"7e229bb4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d2a3edf elementor-widget elementor-widget-text-editor\" data-id=\"d2a3edf\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00a0<\/p><p>\u00a0<\/p><p>the sapheno-popliteal junction<\/p><p>determine competency and the relationship to the knee crease.<br \/>the junction is commonly into the lateral aspect of the popliteal vein.<\/p><p>common variations are:<\/p><ul><li>via muscular veins.<\/li><li>no spj &#8211; giacomini vein variant up to the sfv or lsv in the thigh.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4683d7e0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4683d7e0\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-1e4203e8\" data-id=\"1e4203e8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6c8a104e elementor-flip-box--effect-fade elementor-widget elementor-widget-flip-box\" data-id=\"6c8a104e\" data-element_type=\"widget\" data-widget_type=\"flip-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-flip-box\" tabindex=\"0\">\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__front\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__back\">\n\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6f5e8c94 elementor-widget elementor-widget-text-editor\" data-id=\"6f5e8c94\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>diagram of transverse calf showing the &#8216;eye-like&#8217; fascia containing the ssv.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4d16551f\" data-id=\"4d16551f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2db94cc9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2db94cc9\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-70145f0e\" data-id=\"70145f0e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fce550b elementor-widget elementor-widget-text-editor\" data-id=\"fce550b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00a0<\/p><p>\u00a0<\/p><p>\u00a0<\/p><p>\u00a0<\/p><p>the short saphenous vein may terminate in the giacomini vein with no sapheno-popliteal junction. <br \/>alternatively it may divide, with a normal spj and a giacomini vein (as in this case).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-732f848a\" data-id=\"732f848a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3a374395 elementor-flip-box--effect-fade elementor-widget elementor-widget-flip-box\" data-id=\"3a374395\" data-element_type=\"widget\" data-widget_type=\"flip-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-flip-box\" tabindex=\"0\">\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__front\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"elementor-flip-box__layer elementor-flip-box__back\">\n\t\t\t<div class=\"elementor-flip-box__layer__overlay\">\n\t\t\t\t<div class=\"elementor-flip-box__layer__inner\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6127986 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6127986\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5dbb18a\" data-id=\"5dbb18a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1b60524 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"1b60524\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-34773b8b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"34773b8b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1dec5d0\" data-id=\"1dec5d0\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1b06bc71 elementor-widget elementor-widget-spacer\" data-id=\"1b06bc71\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4d13982d elementor-widget elementor-widget-text-editor\" data-id=\"4d13982d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h1 style=\"text-align: center;\">scan protocol<\/h1>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-718539a5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"718539a5\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-16df96ec\" data-id=\"16df96ec\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2ce66219 elementor-widget elementor-widget-text-editor\" data-id=\"2ce66219\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3><span class=\"ez-toc-section\" id=\"role_of_ultrasound\"><\/span>role of ultrasound<span class=\"ez-toc-section-end\"><\/span><\/h3><p>note: a comprehensive thorough scan can take an hour to complete.<\/p><ul><li>to identify the source and course of varicosities in the lower limb.<\/li><li>to assess these veins pre-operatively as a cause for:<ul><li>venous ulcers<\/li><li>lower limb oedema<\/li><li>venous ezcema<\/li><li>self image<\/li><\/ul><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-40c60455 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"40c60455\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-103b194b\" data-id=\"103b194b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-53de4e63 elementor-widget elementor-widget-text-editor\" data-id=\"53de4e63\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3><span class=\"ez-toc-section\" id=\"limitations\"><\/span>limitations<span class=\"ez-toc-section-end\"><\/span><\/h3><ul><li>ideally the scan should be performed with the patient erect or as upright as possible. some patient will have difficulty with this.<\/li><li>markedly oedematous legs or open ulcers will impede scan quality.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3af6705b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3af6705b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c8ce2b\" data-id=\"c8ce2b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-57783b6d elementor-widget elementor-widget-text-editor\" data-id=\"57783b6d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3><span class=\"ez-toc-section\" id=\"patient_preparation\"><\/span>patient preparation<span class=\"ez-toc-section-end\"><\/span><\/h3><ul><li>ideally the scan should be performed with the patient erect or as upright as possible. some patients will have difficulty with this, occasionally becoming faint or weary.<\/li><li>use of a tilt table will make the scan easier for both you and the patient.<\/li><li>position the patient on their back. gently flex their knee and externally rotate their leg with their unaffected leg kept straight to take the majority of their weight.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-781425ac elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"781425ac\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1b5ac4e5\" data-id=\"1b5ac4e5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-61bd9c26 elementor-widget elementor-widget-text-editor\" data-id=\"61bd9c26\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3><span class=\"ez-toc-section\" id=\"equipment_setup\"><\/span>equipment setup<span class=\"ez-toc-section-end\"><\/span><\/h3><ul><li>use of a medium to high frequency(7-10mhz)linear array probe is preferrable to visualise the superficial veins.<\/li><li>you may need to resort to a lower frequency probe to assess the deep veins, depending on the patient&#8217;s body habitus.<\/li><li>doppler settings should be low prf and low wall filter with medium to high persistance.<\/li><li>set the u\/s machine to display\u00a0<strong>triplex<\/strong>\u00a0&#8211; usually, when spectral doppler is on, there is a &#8216;simultaneous&#8217; option<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6b1ddbb6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6b1ddbb6\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-75a8c125\" data-id=\"75a8c125\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6d4dcd26 elementor-widget elementor-widget-text-editor\" data-id=\"6d4dcd26\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3><span class=\"ez-toc-section\" id=\"common_pathology\"><\/span>common pathology<span class=\"ez-toc-section-end\"><\/span><\/h3><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6cfca187 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6cfca187\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-42bc5952\" data-id=\"42bc5952\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8548997 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"8548997\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6ff14d4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6ff14d4\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-257e20e4\" data-id=\"257e20e4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2e50fec8 elementor-widget elementor-widget-text-editor\" data-id=\"2e50fec8\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h1 style=\"text-align: center;\">scanning technique<\/h1>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-173a2e1f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"173a2e1f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-795c6f47\" data-id=\"795c6f47\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-46cb52df elementor-widget elementor-widget-text-editor\" data-id=\"46cb52df\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h2><span class=\"ez-toc-section\" id=\"deep_veins\"><\/span>deep veins<span class=\"ez-toc-section-end\"><\/span><\/h2><p>post thromotic syndrome in patients with a past history of dvt can lead to deep venous incompetence. deep venous incompetence or current dvt is important to exclude as a cause for the patients symptoms.<\/p><ol><li>begining at the groin in transverse, identify the common femoral vein(cfv) at the point where it bifurcates into the superficial femoral vein(sfv) and proffunda femoris vein(pfv).check compresibility in transverse and image in longitudinally with colour flow.<\/li><li>the external iliac vein (and often cfv) do not have valves so need not be checked for incompetence.<\/li><li>check the competency of the sfv proximally:in longitudinal, using colour and spectral doppler. ask the patient to strain down and make a fat tummy. if incompetent, flow reversal will be evident throughout the strain. note: due to valve spacing you can get up to 0.5 seconds of reversed flow in deep veins.<\/li><li>check the patency and competency of the sfv distally: if the sfv was incompetent proximally, valsalva can be used again, otherwise a short, firm squeeze of the proximal calf (called augmentation) should be used.<\/li><li>check the patency and competency of the popliteal vein(popv). place the probe transversely in the popliteal fossa at the knee crease. the popv and artery will be easily seen (be cautious not to mistake the several muscular veins in the area for the popv). check it&#8217;s competency as per the distal sfv.<\/li><\/ol><h2><span class=\"ez-toc-section\" id=\"the_great_saphenous_vein_gsv\"><\/span>the great saphenous vein (gsv)<span class=\"ez-toc-section-end\"><\/span><\/h2><p>sometimes referred to as the long saphenous vein (lsv).<\/p><ul><li>follow from the sapheno-femoral junction (sfj) groin to the ankle using distal augmentation to assess for incompetence.<\/li><li>if there are changes in competence, note the distance from landmarks such as the groin or knee crease.<\/li><\/ul><h2><span class=\"ez-toc-section\" id=\"the_short_saphenous_vein\"><\/span>the short saphenous vein<span class=\"ez-toc-section-end\"><\/span><\/h2><ul><li>similar to the gsv, in longitudinal, follow the ssv from the sapheno-popliteal junction (spj) in the knee crease, down the midline of the calf.<\/li><li>use distal augmentation to assess for incompetence.<\/li><li>if there are changes in competence, note the distance from landmarks such as the malleoli or knee crease.<\/li><li>the sural nerve runs parallel to the ssv from mid calf down to the heel. if the ssv is incompetent, make note in the report if the sural nerve is in intimate contact with the vein. they can be confused one for the other in surgery.<\/li><\/ul><h2><span class=\"ez-toc-section\" id=\"perforating_veins\"><\/span>perforating veins<span class=\"ez-toc-section-end\"><\/span><\/h2><p>a perforating vein joins the superficial veins to the deep veins. by definition a perforating vein must breech the fascia between the superficial fat and the muscle fascia.<\/p><p>in transverse, scan in a methodical patternup and down the medial calf. begin with the toe of the probe on the tibia and do vertical sweeps until you reach the ssv.<\/p><p>flow should always be superficial to deep (competent).<\/p><p>if flow is observed deep to superficial, the vein is incompetent. any incompetent perforating veins (ipvs) or competent perforators &gt;3mm should be noted in the report.<\/p><table border=\"0\" cellspacing=\"5\" cellpadding=\"0\"><tbody><tr><td>\u00a0<a href=\"\/\/www.iolishoes.com\/wp-content\/uploads\/2018\/07\/perforator-anatomy.jpg\"><img decoding=\"async\" src=\"\/\/www.iolishoes.com\/wp-content\/uploads\/2018\/07\/perforator-anatomy.jpg\" alt=\"\/\/www.iolishoes.com\/wp-content\/uploads\/2018\/07\/perforator-anatomy.jpg\" \/><\/a><\/td><\/tr><tr><td><p><em><strong>common perforators<\/strong><\/em><\/p><p>the most common perforating veins are shown. the &#8216;cocketts&#8217; are by far the most common. these are medial, paratibial in the distal 2\/3 of the lower leg.<\/p><\/td><\/tr><\/tbody><\/table>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2951830c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2951830c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-125e81bd\" data-id=\"125e81bd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4aa2a01c elementor-widget elementor-widget-text-editor\" data-id=\"4aa2a01c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3><span class=\"ez-toc-section\" id=\"basic_hardcopy_imaging\"><\/span>basic hardcopy imaging<span class=\"ez-toc-section-end\"><\/span><\/h3><p>a cvi study should include the following minimum images:<\/p><ul><li>cfv bifurcation<\/li><li>sfv proximal and distal demonstrating patency and competency<\/li><li>popv demonstrating patency and competency<\/li><li>sfj demonstrating patency and competency<\/li><li>spj (if present) demonstrating patency and competency<\/li><li>any incompetent perforators noting their diameter, depth and position relative to a surface landmark<\/li><li>any significant or atypical junctions of varices to the &#8216;normal&#8217; system<\/li><li>any incidental pathology such as thrombus, bakers cyst or popliteal aneurysm.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>flow dynamics normal venous flow and valve movement, \u00a0 \u00a0 normal flow in the normal cicumstance, the superficial system drains the subcutaneous tissues and periodically empties into the deep system via perforating veins. flow direction should always be: cephalad. superficial to deep. incompetent valve &amp; perforator leading to venous reflux. \u00a0 \u00a0 incompetent flow with [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"tags":[],"class_list":["post-280","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"\/\/www.iolishoes.com\/wp-json\/wp\/v2\/pages\/280","targethints":{"allow":["get"]}}],"collection":[{"href":"\/\/www.iolishoes.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"\/\/www.iolishoes.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"\/\/www.iolishoes.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"\/\/www.iolishoes.com\/wp-json\/wp\/v2\/comments?post=280"}],"version-history":[{"count":0,"href":"\/\/www.iolishoes.com\/wp-json\/wp\/v2\/pages\/280\/revisions"}],"wp:attachment":[{"href":"\/\/www.iolishoes.com\/wp-json\/wp\/v2\/media?parent=280"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"\/\/www.iolishoes.com\/wp-json\/wp\/v2\/tags?post=280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}