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Adv. Vas. Son.

Test 2 Arterial Lower Extremity Duplex Scanning

QuestionAnswer
What is the most common PT position for a lower extremity arterial exam? PT supine with knee slightly flexed and thigh abduction
What PT position may be used to evaluate the Popliteal artery, Tibioperoneal trunk, and Peroneal artery? Lateral Decubitus
What transducer is used for Lower extremity arterial exams? 5-2 MHz curvlinear &/ or phased array
What transducer is useful for aprtoiliac scanning and deeper lower extremity vessels in heavier limbs? 3-2 MHz TD
What TD is useful for the majority of lower extremity vessels? 7-4 MHz linear
What TD allows better visualization of more superficial vessels, especially near ankle and foot? 15-7 MHz High resolution linear
Where should the lower extremity ultrasound exam begin? At the groin
What vessels should be examined in a lower extremity exam? Distal External Iliac Artery (EIA), Common Femoral Artery (CFA), Superficial Femoral Artery(SFA), Profunda Femoris Artery (PFA)-AKA deep fem, Popliteal artery (Pop A), Posterior Tibial artery (PTA), Anterior Tibial artery (ATA), Peroneal artery (Per A)
What approach should the CFA, SFA, and PFA be examined from? A medial approach
When stenosis is present where should velocities and waveforms be recorded? Proximal to the stenosis, in the stenosis, and distal to the stenosis
What is the velocity ratio? Velocity in stenosis/Velocity proximal to stenosis
PSV velocity ratio <2=? Normal
PSV velocity ratio ≥2=? ≥50% stenosis (Moderate)
PSV velocity ration ≥3=? ≥70% stenosis (Severe)
If an aneurysm is present where should the diameter measurements be made? At the area of maximal dilation and from an arterial segment just proximal
What are some abnormal color findings? Aliasing, Reduced flow channel, and Color bruit
What are the normal findings for spectral analysis? PSV that does not focally increase. Velocities typically <125 cm/s in lower extremity arteries. Velocities will decrease as you move distally (normal)
Normal high-resistance spectral waveform has what? Sharp upstroke, Rapid deceleration, Reflected wave w/ retrograde flow in early diastole, Brief wave of antegrade flow in mid to late diastole= Triphasic waveform
Distal to hemodynamically significant stenosis the spectral waveform can be expected to have? More low resistance characteristics (flow throughout diastole) Delayed rise to peak systole
Proximal to occlusion or near occlusion the waveform will display what? Very high resistance pattern, Antegrade flow component only during systole, No flow during diastole
What are the duplex advantages? Portable, Nearly immediate exam performance & interpretation, Ability to visualize arterial walls not just lumen, Ability to see acute & chronic arterial changes, & Ability to eval other vascular segments as needed for intervention
What are the Pitfalls? Calcified vessels, Extremely low flow, Uncooperative PTs, Swelling &/or depth of vessels may limit visualization, & Exam length in complicated cases
What is considered the Gold Standard of diagnosis of arterial stenosis? Contrast Arteriography
Contrast Arteriography can be used when duplex imaging is limited such as:? Severe arterial calcifications, Severe edema or morbid obesity, Extensive skin wounds, and Extremely low flow
What are the limitations of arteriography? Delineates patent arterial lumen only, misses thrombosed Pop aneurysms, Fails to visualize outflow & inflow in v low-flow situations, Requires potentially nephrotoxic agents, Requires use of ionizing radiation, Delays prompt treatment
Created by: EmilyGriffin
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