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Ultrasound Assessment Lower Extremity Arteries Ultrasound Assessment When Adjunct to physiologic testing Determine stenosis vs. occlusion Determine level and extent of occlusion May assist in determination of treatment Angioplasty vs. surgical

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ultrasound assessment

Ultrasound Assessment

Lower Extremity Arteries

ultrasound assessment2
Ultrasound Assessment
  • When
    • Adjunct to physiologic testing
      • Determine stenosis vs. occlusion
      • Determine level and extent of occlusion
      • May assist in determination of treatment
        • Angioplasty vs. surgical
    • Patients with renal failure who cannot have arteriography or MRA
    • Trauma
ultrasound imaging
Ultrasound Imaging
  • Modalities
    • B-mode
    • Spectral Doppler
    • Color Doppler
    • Power Doppler
ultrasound imaging4
Ultrasound Imaging
  • B-mode
    • Evaluate vessel walls for:
      • Stenosis due to:
        • Calcification (medial calcinosis)
        • Plaque formation
        • Thrombus
      • Aneurysmal dilatation, measure
        • Longitudinal diameter
          • Make vessel as wide as possible
        • Transverse diameter
          • Make vessel as narrow as possible
ultrasound imaging5
Ultrasound Imaging
  • Spectral Doppler
    • Determine peak systolic & end diastolic velocities
      • Use PSV’s to calculate systolic velocity ratios
        • > 2.0 = > 50% stenosis
        • > 4.0 = > 75% stenosis
    • Some labs determine volume flow
      • No validation or normals determined
ultrasound imaging6
Ultrasound Imaging
  • Color Doppler Flow Imaging
    • Assists in determining the presence of flow
      • Must set appropriate scale (PRF)
        • Low PRF for question of occlusion
    • Assists in determining laminar vs. turbulent flow
      • Must set appropriate scale (PRF)
    • Assists in placement of spectral Doppler sample volume at point of greatest velocity
    • Assists in the detection of collaterals
ultrasound imaging7
Ultrasound Imaging
  • Power Doppler
    • Assists in determining the presence of flow
      • More sensitive in detecting low flow than color Doppler
    • Can use simultaneous spectral Doppler
    • May assist in the detection of collaterals
    • No directional information
classifying peripheral artery lesions
Classifying Peripheral Artery Lesions
  • Normal
    • Triphasic waveform
    • No spectral broadening
classifying peripheral artery lesions11
Classifying Peripheral Artery Lesions
  • 1 – 19% diameter reduction
    • Triphasic waveform
    • Minimal spectral broadening
    • PSV increased <30% relative to the adjacent proximal segment
    • Proximal & distal waveforms remain normal
classifying peripheral artery lesions12
Classifying Peripheral Artery Lesions
  • 20 – 49% diameter reduction
    • Triphasic waveform usually maintained; reverse flow component may be diminished
    • Prominent spectral broadening
    • PSV increased 30 – 100% relative to the adjacent proximal segment
    • Proximal & distal waveforms remain normal
classifying peripheral artery lesions13
Classifying Peripheral Artery Lesions
  • 50 – 99% diameter reduction
    • Monophasic waveform with loss of reverse flow component
    • Extensive spectral broadening
    • PSV increased >100% relative to the adjacent proximal segment
    • Distal waveform is monophasic with reduced systolic velocities
classifying peripheral artery lesions14
Classifying Peripheral Artery Lesions
  • Occlusion
    • No flow detected within imaged arterial segment
    • Preocclusive “thump” may be heard just proximal to site of occlusion
    • Distal waveforms are monophasic with reduced systolic velocities