1. Doppler ultrasound of normal venous flow
Samir Haffar M.D.

2. Normal venous flow
 Spontaneity Spontaneous flow without augmentation
 Phasicity Flow changes with respiration
 Compression Transverse plane
 Augmentation Compression distal to site of examination
Patency below site of examination
 Valsalva Deep breath, strain while holding breath
Patency of abdominal & pelvic veins

3. Normal venous flow
 Spontaneity Spontaneous flow without augmentation
 Phasicity Flow changes with respiration
 Compression Transverse plane
 Augmentation Compression distal to site of examination
Patency below site of examination
 Valsalva Deep breath, strain while holding breath
Patency of abdominal & pelvic veins

4. Normal venous flow
 Spontaneity Spontaneous flow without augmentation
 Phasicity Flow changes with respiration
 Compression Transverse plane
 Augmentation Compression distal to site of examination
Patency below site of examination
 Valsalva Deep breath, strain while holding breath
Patency of abdominal & pelvic veins

5. Phasicity
Flow changes with respiration
Slow ApneaRapid

6. Normal venous flow
 Spontaneity Spontaneous flow without augmentation
 Phasicity Flow changes with respiration
 Compression Transverse plane
 Augmentation Compression distal to site of examination
Patency below site of examination
 Valsalva Deep breath, strain while holding breath
Patency of abdominal & pelvic veins

7. Compressibility of veins
Do not press too hard since the normal vein collapses
very easily making it difficult to find

8. External compression of the veins
CompressionRelaxation

9. Incompressibility = Thrombus
Do not compress vein more than necessary in acute thrombus
Fear of detaching thrombus to cause PE
Myers KA & Clough A. Making sense of vascular ultrasound. Arnold, London, 2004.

10. Transverse compression of veins
Normal vein
Complete collapse
Nonocclusive thrombosed vein
Partial collapse
Completely thrombosed vein
No collapse
Hamper UM et al. Radiol Clin N Am 2007 ; 45 : 525 – 547.

11. Normal venous flow
 Spontaneity Spontaneous flow without augmentation
 Phasicity Flow changes with respiration
 Compression Transverse plane
 Augmentation Compression distal to site of examination
Patency below site of examination
 Valsalva Deep breath, strain while holding breath
Patency of abdominal & pelvic veins

12. Augmented flow in popliteal vein
Aug Valve closed
Competent
vein

13. Normal venous flow
 Spontaneity Spontaneous flow without augmentation
 Phasicity Flow changes with respiration
 Compression Transverse plane
 Augmentation Compression distal to site of examination
Patency below site of examination
 Valsalva Deep breath, strain while holding breath
Patency of abdominal & pelvic veins

14. Valsalva’s maneuver
A V
At rest
A V
Valsalva

15. Valsalva’s maneuver
End
Valsalva
Start
Valsalva
Competent vein

16. Venous valve
Two cups of a valve clearly seen
It is uncommon to see venous valves with this clarity
Stasis of blood evident behind one of the valve cups

17. Venous reflux
Significant venous reflux
of > 2 sec duration
Augmentation
or Valsalva

18. Grading of venous reflux
Grade Reflux duration
Normal valve function Reflux duration of < 0.5 sec
Rapid closure of venous valves
Moderate reflux Reflux duration of 0.5 – 1 sec
Mild to moderate retrograde flow
Significant reflux Reflux duration of > 1 sec
Large volume of retrograde flow
Thrush A, Hartshorne T. Peripheral vascular ultrasound: How, why and when.
Elsevier Churchill Livingstone, London, 2nd edition, 2005.

19. Venous stasis
Echogenic speckle pattern of a deep calf vein
Movement of blood is visible in real time
Echogenic
Blood

20. Thank You