AVF Joint APP and PIT Session: Live Ultrasound Case Teaching
Case-Based Ultrasound Teaching
Faculty and trainees work through four volunteer patients, pairing history-taking and physical exam with live duplex scanning. Trainees ask about prior clots, prior procedures, walking tolerance, and how symptoms respond to elevation and compression before scanning.
Physical Exam and CEAP
The group practices grading edema, checking pulses, and eliciting the Stemmer sign between the toes to flag lymphatic involvement. Skin change and varicosity findings are mapped to CEAP classes, reinforcing that history alone predicts venous involvement before imaging confirms it.
Duplex Findings and Reporting Language
Scans show saphenous vein harvest, rouleaux formation as a stasis marker, and a noncompressible small saphenous segment from a recent closure. Faculty stress calling this an ablation-related thrombus extension rather than thrombus, and labeling old clot chronic post-thrombotic change rather than chronic DVT.
Technique and Surveillance
Discussion covers standing versus supine reflux testing, Valsalva versus abdominal compression, perforator measurement, and why most patients no longer need routine post-ablation duplex absent new symptoms, hypercoagulability, or an unfamiliar operator.
