Vein mapping

1. Vein Mapping At re*be
How and why we do it.

2. 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. $$$$$

3. 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
[phone]
[phone] 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

4. 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.

5. 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.

6. 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.

7. 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.

8. The legend for the mapping
Symbols
•Symbols
•These go in the
symbol box.
There are 4
of these
boxes on
the form.

9. 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.

10. 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

11. 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.

12. Veins of the Deep System are
Checked For
•Compression
•Flow
•Clot

13. 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.

14. Flow
•Color Doppler Ultrasound allows flow to be
checked.
•Red means flow away from the heart.
•Blue means flow toward the heart.

15. 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.

16. Evaluation Points
•Common Femoral Vein
•Femoral Vein
•Popliteal Vein
•Smaller calf veins

17. Documentation

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

19. 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.

20. 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)