Lower Extremity Venous Protocol

Scan through and verify patent venous system before augmenting

Structure Scan Plane Label Images Stored

Identify RT or LT
Transverse EIV Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
External Iliac
Sagittal EIV Color Doppler
Vein
EIV Color & Spectral Doppler with
augmentation
Transverse CFV/GSV Gray Scale CFV & GSV- without
Dual Screen W/COMP compression
Common Gray Scale CFV & GSV-with
Femoral & compression
Great Sagittal CFV/GSV Color Doppler CFV & GSV
Saphenous Vein CFV CFV-Color & Spectral Doppler with
Junction augmentation
GSV GSV-Color & Spectral Doppler with
augmentation
Transverse FV CENT/DFV Gray Scale FV Central & DFV- without
Femoral Vein Dual Screen W/COMP compression
Central & Deep Gray Scale FV Central & DFV-with
Femoral Vein compression
(aka Profunda Sagittal FV CENT/DFV Color Doppler FV Central & DFV
Femoris Vein) FV CENT FV Central-Color & Spectral Doppler
with augmentation
DFV DFV-Color & Spectral Doppler with
augmentation
Transverse FV MID Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Femoral Vein
Sagittal FV MID Color Doppler
Mid
FV MID Color & Spectral Doppler with
augmentation
Transverse FV PERIPH Gray Scale- without compression
Femoral Vein
Dual Screen W/COMP Gray Scale-with compression
Peripheral
Sagittal FV PERIPH Color Doppler
*Hunters Canal
FV PERIPH Color & Spectral Doppler with
augmentation
Transverse POP V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Popliteal Vein Sagittal POP V Color Doppler
POP V Color & Spectral Doppler with
augmentation
Transverse PTV Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Posterior Tibial
Sagittal PTV Color Doppler
Veins
PTV Color & Spectral Doppler with
augmentation
Peroneal Veins Transverse PERONEAL V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Sagittal PERONEAL V Color Doppler

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 Lower Extremity Venous Protocol
PERONEAL V Color & Spectral Doppler with
augmentation

Anatomy/Image Correlation

Vein with
Artery Vein Artery
Compressi
Vein with Spectral
on
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/ non-
compressible 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 distal 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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