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Vascular sonography
Duplex scanning (ARTERIAL)
| Question | Answer |
|---|---|
| What is the most common position for a lower extremity duplex exam? | Supine with knee slightly flexed and thigh abduction |
| How can a patient also be positioned to evaluate the popliteal artery, tibioperoneal trunk, and peroneal artery? | Left lateral decubitus position |
| What transducer is useful for the majority of lower extremity vessels? | Linear 4-7 MHz |
| What transducer may be used for aortoiliac scanning and deeper lower extremity vessels in heavier limbs? | 3-2 MHz Curvilinear |
| What transducer may be used for vascular? | 5-2 MHz curvilinear and/or phased array |
| What transducer may allow better visualization of more specific vessels, especially near the ankle and foot? | High resolution linear 15-7 MHz |
| Where should a lower extremity ultrasound begin? | At the groin |
| What vessels are examined for lower extremity arterial exams? (8 of them) | Distal External iliac Artery (EIA) Common Femoral Artery (CFA) Superficial Femoral Artery (SFA) Profunda Femoris Artery (PFA) |
| Which arteries can be examined from a medial approach to limb? | CFA, SFA, and PFA |
| The PFA only needs to be evaluated where? | In the PROXIMAL segment |
| Where should the SFA be evaluated? | Throughout the ENTIRE LENGTH OF THIGH |
| What does the SFA turn into? | SFA turns into Popliteal |
| Where does the SFA become the Popliteal? | As it passes through the adductor canal |
| Where is the Popliteal artery examined through? | Popliteal is examined through the Popliteal fossa (look behind back of knee) |
| Where can the Gastrocnemius artery be observed? | When scanning the Popliteal behind the knee you can also see the gastrocs--- through the popliteal fossa |
| Where can the Anterior Tibial Origin be seen? | In the Popliteal fossa, then the remainder can be followed with an anterolateral approach |
| Posterior Tibial and Peroneal can be followed with a ______ approach? | MEDIAL approach |
| What is another way that the Peroneal artery may be examined besides a medial approach? | Posterolateral approach |
| Prox, mid and distal images should be taken for what arteries? | SFA and Tibial vessels |
| What are color and/or power doppler used for? (4 things) | Assists with localization and tracking of vessles Rapid assessment of flow dynamics Placement of doppler sample volume Power doppler useful in low flow states or vessel occlusion |
| What is Hyperplasia? | An overgrowth of tissue |
| What is Spectral Doppler used as a primary tool for? | To catergorize disease (tells if it is mild, mod, or severe) |
| Where should PSV (Pulsed Spectral Doppler) be recorded? | In all major vessels |
| When disease is present (stenosis), velocities and waveforms should be recorded where? | Prox to the stenosis, in the stenosis, and distal to the stenosis |
| What are velocity ratios useful for? | To help classify disease severity |
| What is the velocity ratio formula? | Velocity in stenosis/ Velocity proximal to stenosis |
| What is a NORMAL PSV velocity ratio? | <2 is NORMAL |
| What is a MODERATE PSV velocity ratio? | greater than or equal to 2 = greater than or equal to 50% stenosis is MODERATE |
| What is a SEVERE PSV velocity ratio? | greater than or equal to 3 = greater than or equal to 70% stenosis is SEVERE |
| Waveform PROXIMAL to stenosis will look like what? | Resistive and dampened |
| Waveform at the stenosis will look like what? | Max velocity |
| Waveform DISTAL to stenosis will look like what? | Post stenotic turbulence with a little reversal (TARDUS PARVUS) |
| Are we more interested in peak systolic pressure or diastole? | PEAK SYSTOLIC |
| If aneurysmal disease is present what diameter measurements should be made? (2 of them) | At the area of maximal dilatation and from the arterial segment just Proximal to the aneurysm |
| If you have a Popliteal aneurysm you probably have a what? | An Aortic aneurysm |
| What are the characteristics of NORMAL arterial walls? | Smooth and Uniform |
| How can atherosclerotic plaque be described as? (4 characteristics) | Homogenous or heterogenous Smooth or irregular |
| What may be present that causes acoustic shadowing? | Calcifications |
| Aneurysmal disease can be _______ and _________. | BILATERAL and MULTILEVEL |
| Aneurysm is present if the diameter of the vessel is ___ times greater than the adjacent, more proximal segment. | 1.5 times greater |
| What may be present with an aneurysm ? | A thrombus |
| Should you document the presence or the absent of a thrombus when there is an aneurysm? | You must document BOTH PRESENCE and ABSCENCE |
| NORMAL color flow should completely _____ vessel lumen. | FILL vessel lumen |
| Color should be what? (2 things) | Uniform and limited to lumen only |
| ABNORMAL color findings include what? (3 of them) | Aliasing, Reduced flow channel, Color bruit |
| What do you need to know about aliasing? | If it is real (pathology) or not |
| What is reduced flow channel? | Not filling in the vessel all the way |
| What is a color bruit? | Color on the outside of the vessel because the walls are vibrating so hard |
| How do you fix color? | Turn up color gain until it speckles then turn it back down, and turn down color scale until aliasing then turn it back up a little |
| What are NORMAL findings of spectral doppler? (2 things) | PSV that does not focally increase (velocities will decrease as you move distally), High resistance waveform |
| What is the typically velocity in lower extremity arteries? | < 125cm/s |
| If the velocity slows down if you move distally that is? | NORMAL |
| If the velocity speeds up if you move distally that is? | ABNORMAL |
| How would you describe a TRIPHASIC waveform? | Sharp upstroke, Rapid deceleration, Reflected wave with retrograde flow in early diastole, Brief wave of antegrade flow in mid to late diastole |
| Distal to a hemodynamically significant stenosis the spectral waveform can be expected to have what? (2 things) | More low resistance characteristics (flow throughout diastole), Delayed rise to peak systole (TARDUS PARVUS) |
| What type of waveform can be observed immediately after exercise? | A waveform displaying a normal systolic upstroke with constant forward flow through diastole |
| Abnormal finding proximal or near occlusion, what will the waveform display? | Very high resistance pattern Antegrade flow component only during systole No flow during diastole Diastole disappeared |
| What are the advantages of duplex? (6 of them) | Portable Nearly immediate exam performances and interpretation Able to visualize arterial walls not just lumen Able to visualize acute and chronic arterial changes Able to evaluate other vascular segments as needed for intervention Site of disease |
| What are the pitfalls of duplex? (5 of them) | Calcified vessels Extremely low flow Uncooperative patients Swelling and/or depth of vessels may limit visualization Exam length in complicated cases |
| What is considered the gold standard for diagnosing arterial stenosis? | Contrast Arteriography |
| When duplex imaging is limited what can be used to instead? | Carotid Arteriography |
| What are some reasons that carotid arteriography might be used instead of duplex? (4 of them) | Severe arterial calcifications Severe edema or morbid obesity Extensive skin wounds Extremely low flow |
| What are some limitation of arteriography? (6 of them) | Delineates patent arterial lumen only Misses thrombosed popliteal aneurysms Fails to visualize inflow and outflow in v low slow situations Requires potentially nephrotoxic agents Requires an ionizing material Delays prompt treatment |
Created by:
EmilyGriffin
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