下肢血管-英文

《下肢血管-英文》由会员分享，可在线阅读，更多相关《下肢血管-英文（100页珍藏版）》请在装配图网上搜索。

1、Peripheral Vascular Ultrasound The 2nd affiliated Hosp. of GZMU Luo YanHua1060240 The anatomy of the peripheral vascular1. The arterial anatomy of the upper limbSubclavian artery,Axillary artery,Brachial arteryRadial artery,Ulnar artery. The anatomy of the peripheral vascular2. The arterial anatomy

2、of the lower limbCommon femoral artery, Superficial femoral artery,Profunda femoris artery,Popliteal artery, Anterior tibial artery, Posterior tibial artery, Tibioperoneal trunk,Peroneal artery, Dorsalis pedis artery. The arterial anatomy of the lower limb The anatomy of the peripheral veins1. The u

3、pper limb venous system can be divided into the deep and superficial veins.The main deep veins of the upper limb: Radial vein,Ulnar vein, Brachial vein,Axillary vein, Subclavian vein. The anatomy of the peripheral veins The main superficial veins of the upper limb: Cephalic vein, Basilic vein, Media

4、n cubital vein. The anatomy of the peripheral veins2. The main deep veins of the lower limb:Anterior tibial veins, Posterior tibial veins, Peroneal veins, Popliteal vein, Superficial femoral vein, Profunda femoris vein,Common femoral vein. The anatomy of the peripheral veins The main superficial vei

5、ns in the lower limbs are the long saphenous vein (LSV) and short saphenous vein (SSV). The anatomy of the peripheral veins 3. Veins contain valves to prevent the reflux of blood to the extremities. Venous valves are bicuspid. Technical Aspects1. Patient preparation： Dont need preparation.2. Patient

6、 position: in supine and erect position, prone.the limb is supinated and slightly abducted. Technical Aspects3. Equipment requirement A high-capacity scan converter the upper limb: 5 10MHz the lower limb: 5 7MHz 4. Methods： longitudinal scan plane and transverse plane.Dont abducted strongly, as the

7、veins can be compressed. 1.B-mode images: the lumen of a normal peripheral artery should appear clear, and the walls should be uniform along each arterial segment. A longitudinal B-mode image of the superficial femoral artery, profunda femoris artery 2. Color flow images： There should be color filli

8、ng to the vessel walls. A longitudinal color flow image of the common femoral artery A transverse color flow image of the common femoral artery 3. Spectral Doppler： The normal spectral doppler display demonstrates a triphasic flow pattern with a clear spectral window. In elderly patients or patients

9、 with poor cardiac output, the wave form may be biphasic or even monophonic. 1. B-mode images: The vein should appear clear and contain no echoes. The vein can be compressed. 2. Color flow images: Spontaneous phasic flow is usually seen in the larger veins. There should be complete color filling of

10、the lumen in both longitudinal and transverse planes during a calf squeeze. Anterior tibial veins 3. Spectral Doppler: The Doppler signal at the level of the common femoral vein should exhibit a spontaneous phasic flow pattern, which temporarily ceases when the patient performs a Valsalva maneuver.

11、spectral doppler of the superficial femoral vein the patient takes a deep inspiration or performs a Valsalva maneuver spectral doppler of popliteal vein, at rest 1.The earliest ultrasound sign is thickening of the intima and media (1.0mm) , in the bifurcation (1.2mm) 1. Atheroma： the intima and medi

12、a (1.5mm) Multilevel disease and bilateral involvement are common.L-CFA R-CFA 2. Color flow images：Flow signals change to be fine or defect.Arterial stenoses will be demonstrated as areas of color flow disturbance or aliasing. An occlusion is demonstrated by a total absence of color flow in the vess

13、el. 3. Spectral Doppler：If the artery is no significant stenosis, spectral doppler is normal. In the presence of a significant stenosis, there will be an increase in flow velocity across the lesion associated with spectral broadening and turbulence just distal to the lesion. 1.B-mode images： The art

14、ery appears abnormally enlarged, the lesion diameter is 1.5 times more than the adjacent normal diameter, wall of the aneurysm is artery wall . 1.B-mode images：The shape of the aneurysm can vary, you could found hypoechoic thrombosis in the aneurysm.B-mode imaging is used to assess the size, length

15、and amount of thrombus within the aneurysm. 2. Color flow images if complete occlusion, no flow signal in the artery. 4. Spectral Doppler: Variation Mild lesions: a triphasic flow pattern with a clear spectral window; most cases: the wave form may be monophonic； complete occlusion: no wave form can

16、be found. male ,56Y anterior tibial artery male ,56Y anterior tibial artery male ,56Y anterior tibial artery 1. Clinical: Often involving the aorta and its branches, chronic non-specific inflammation, more common in young women. Arterial wall stiffness, calcification and atrophy, adhesion with surro

17、unding tissue, stenosis or occlusion2. B-mode image: More than two vessels affected；vascular wall uneven thickening, Uneven echo, stenosis or occlusion. 3. Color flow images: Not severe stenosis, blood flow in a single color; With the increasing degrees of the stenosis, flow signals changed to be fi

18、ne; no flow signals can be found in occlusion.4. Spectral Doppler: Variation Diffuse lesions: the wave form may be monophonic， low speed flow spectrum; Local stenosis: high speed flow spectrum; Occlusion:no wave form can be found. The wall of common carotid artery thickening, but intima is still smo

19、oth, the lumen is narrowing. The wall of common carotid artery thickening, lumen is obviously smaller. Color flow images :The lumen is narrowing. Blood velocity increased. Spectral Doppler of subclavian artery, the lumen is narrowing, blood velocity increased, near 4m/s. 1. B-mode images:In the pres

20、ence of thrombus the vein will not compress. In the very early stages of thrombosis, the clot often has a degree of echogenicity. Within 1 or 2 days, the clot becomes more anechoic. it is often possible to seesubtle echoes. If the vein is totally occluded in the acute phase, it may appear distended.

21、Older thrombus, beyond two weeks in age, becomes more echogenic. A longitudinal B-mode image of a common femoral vein thrombosis A transverse B-mode image of a peroneal vein thrombosis 2. Color flow images: There is an absence of color filling in occluded veins, even with distal augmentation. This c

22、an be demonstrated in both longitudinal and transverse sections. A longitudinal color image of asuperficial femoral vein thrombosis A transverse color image of a superficial femoral vein thrombosis A color flow image of superficial femoral vein. Flow is seen between the thrombus and vein wall. 3. Sp

23、ectral Doppler: There is an absence of a spectral Doppler signal when the vein is completely occluded. When the vein contains a significant amount of partially occluding or free-floating thrombus, there is normally a reduced flow pattern, which demonstrates little or no augmentation following distal

24、 compression. During Valsalva testing, if there has reflux across the vein, more than 1s, we call this disease Valsalva test: The patient is told to inhale deeply and then to push out and expand the cheeks without breathing out, while at the same time bearing pressure down on the abdomen. This produ

25、ces an increase in intra-abdominal pressure, thus increasing the venous blood pressure in the iliac and femoral veins. During Valsalva testing, it is usual to see the common femoral vein distending , there should be no reflux across the proximal superficial femoral vein. evere venous reflux of 2s duration is demonstrated across the venous valvular .Spectral Doppler is used to grade the duration of venous reflux. Which disease did this patient suffer from?