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Chapter 35. Veins & Lymphatics

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Which statement regarding the treatment of varicose and perforator veins is true?

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A. Surgical and chemical ablations are preferred ­compared to thermal ablation of the GSV

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B. Selective treatment of incompetent varicose veins is recommended in patients with simple varicose veins

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C. Thermal ablation is an effective approach to the treatment of saphenous veins

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D. Vein reabsorption after thermal ablation occurs over the course of a few days

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C. Thermal ablation is an effective approach to the treatment of saphenous veins. The 2011 consensus opinion recommends thermal ablation to surgical or chemical ablation for GSVs. Selective treatment of incompetent perforating veins is not recommended in patients with simple varicose veins, though is an option for pathologic perforating veins. Vein absorption occurs over the course of months.

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Three months’ anticoagulation is recommended for which of the following?

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A. In patients with PE/an isolated distal DVT of the leg provoked by surgery

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B. In patients with PE/proximal DVT of the leg ­provoked by a nonsurgical transient risk factor

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C. All patients with DVT

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D. A and B

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D. Three months’ anticoagulation is similarly recommended in patients with (i) PE/proximal DVT of the leg provoked by a nonsurgical transient risk factor, (ii) in patients with PE/an isolated distal DVT of the leg provoked by surgery or by a nonsurgical transient risk factor. This is recommended over a longer or shorter duration of anticoagulation. Not all patients with DVT require anticoagulation for this period of time.

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Which imaging study is an appropriate initial evaluation in patients with suspected axillary-subclavian vein thrombosis?

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A. CT angiogram

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B. CT venogram

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C. Chest x-ray

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D. Upper extremity venous duplex ultrasound

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D. Upper extremity venous duplex ultrasound. Upper extremity venous duplex ultrasound is both sensitive and reliable in the diagnosis of axillary-subclavian vein thrombosis. A chest x-ray is obtained to exclude the presence of cervical ribs which can contribute to the compression of the subclavian vein, but cannot be used solely in diagnosis. A CT venogram is not an appropriate initial evaluation modality. A CT angiogram will not properly image the subclavian vein.

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Which of the following regarding superficial thrombophlebitis is true?

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