Guidelines, Policies and Statements D19 Statement on Visceral Vascular Testing Using Ultrasound

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1 Guidelines, Plicies and Statements D19 Statement n Visceral Vascular Testing Using Ultrasund Disclaimer and Cpyright The ASUM Standards f Practice Bard have made every effrt t ensure that this Guideline/Plicy/Statement is accurate and reflects best practice at the time at which they are issued. The infrmatin prvided in this dcument is f a general nature nly and is nt intended as a substitute fr medical r legal advice. The Sciety, emplyees and members d nt accept any liability fr the cnsequences f any inaccurate r misleading data/pinins r statements issued by ASUM. Apprved Guidelines may be distributed freely with the permissin f ASUM asum@asum.cm.au Page 1 f 6 01/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W ACN ABN ISO 9001 certified by BSI under Certificate N. FS

2 Guidelines, Plicies and Statements D19 Statement n Visceral Vascular Testing Using Ultrasund May 2006 (Reaffirmed July 2007) Sectin 1: Instrumentatin Essential Equipment: Regular equipment maintenance is t be perfrmed n all equipment used fr vascular ultrasund. The duplex Dppler ultrasund machine is used t prvide simultaneus r sequential real-time greyscale (B-mde) imaging f the vessel wall and plaque analysis f the angle crrected Dppler frequency spectrum frm a selected sample vlume within the vessel lumen. As well as the essential characteristics f bth B-mde imaging and duplex Dppler spectral analysis fr quantificatin f bld flw velcities (r Dppler frequency shift) the ultrasund machine shuld have clur Dppler imaging. Clur Dppler prvides a qualitative, simultaneus display f flw infrmatin superimpsed n the real time greyscale image. Required characteristics: Imaging frequencies as specified in anatmic reginal sectins Range-gated Dppler with the ability t adjust the psitin and size f the range gate/sample vlume Prvisin fr the measurement and display f the Dppler angle Prvisin f visual and audible utput f Dppler signal Prvisin fr hard cpy r ther frm r recrding Specific Characteristics A wide range f imaging frequencies shuld be available A wide range f types f transducer (i.e. phased array, linear and sectr) shuld be available. Clur Dppler image capabilities Sectin 2: Indicatins and Techniques Indicatins Indicatins will vary depending n clinical cnsideratins assessed at the time f the examinatin. Generally accepted indicatins include: - Evaluatin f the mesenteric arterial system: Suspected celiac/sma insufficiency Aneurysm/pseudaneurysms Evaluatin f the hepat/prtal circulatin Suspected prtal hypertensin Page 2 f 6 01/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W ACN ABN ISO 9001 certified by BSI under Certificate N. FS

3 Suspected prtal vein thrmbsis Prtal system t systemic shunt evaluatin Suspected pseudaneurysms/av fistula Primary hepatic malignancies Suspected cclusin/stensis/aneurysm Pre-p evaluatin fr hepatic transplants Suspected hepatic ven-cclusive disease Suspected heart disease/cnstrictive pericarditis Unexplained ascites Unexplained splenmegaly Pancreatic disease Evaluatin f native renal arteries/veins Screening fr renvascular hypertensin Screening fr ischaemic nephrpathy Mnitring f knwn renal artery stensis Suspected renal vein cclusin Mnitring and review f renal artery interventin. Evaluatin f renal transplants Renal transplant dysfunctin Presence f bruit ver allgraft Evaluatin f liver transplants Pst-p hepatic dysfunctin Techniques Apprpriate techniques shall be used fr the evaluatin f the visceral vascular circulatin. Patient preparatin may be necessary t minimise bwel gas. Evaluatin f the mesenteric arterial system: The curse f the abdminal arta, celiac axis, hepatic, splenic, superir mesenteric and inferir mesenteric arteries shuld be evaluated s that the presence and extent f disease can be dcumented Imaging: The study shuld dcument vessel anatmy and mrphlgy with high quality imaging. Haemdynamics: The study dcuments vessel haemdynamics by sampling f the apprpriate vessels. Velcity determinatins are made with knwledge f the angle between the ultrasund Page 3 f 6 01/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W ACN ABN ISO 9001 certified by BSI under Certificate N. FS

4 beam and the vessel being examined. Velcity r frequency measurements and spectral wavefrm characteristics are recrded at representative sites within the vessels. Evaluatin f the hepat/prtal circulatin Examinatin f the hepatic and splenic parenchyma is an essential part f the examinatin. A thrugh examinatin f the arteries and veins within the hepat/prtal circulatin using B-mde imaging, clur Dppler imaging and pulsed Dppler mdalities shuld be carried ut. The curse f the main prtal vein, right and left prtal veins, the hepatic veins, inferir vena cava, splenic vein, superir mesenteric vein, shuld be evaluated s that the presence and extent f disease can be dcumented. Regins f pssible vessel recanalisatin (e.g. Ligamentum Teres fr paraumbilical vein), r f varix frmatin, as well as the inflw and utflw vessels f prtsystemic shunts are t be part f the examinatin. Imaging: The study shuld dcument vessel and rgan anatmy and mrphlgy with high quality imaging. Haemdynamics: The study dcuments vessel haemdynamics by sampling f the apprpriate vessels. The presence r absence, directin and type f flw within the vessels are dcumented. The presence f cllateral vessels shuld be dcumented. Velcity r frequency measurements and spectral wavefrm characteristics are recrded at representative sites within the vessels. Evaluatin f native renal arteries/veins. Renal Arteries Examinatin f the renal parenchyma is an essential part f the examinatin with the ple t ple length being measured. A thrugh examinatin f the arteries and veins within the renal circulatin using B-mde imaging, clur Dppler imaging and pulsed Dppler mdalities shuld be carried ut. The curse f the abdminal arta, renal and intra renal arteries are t be evaluated s that the presence and extent f disease can be dcumented. Renal Veins Examinatin f the renal parenchyma is an essential part f the examinatin, with the renal length being measured. Evaluatin f bth kidneys and renal veins is essential. A thrugh examinatin f the veins within the renal circulatin using B-mde imaging, clur Dppler imaging and pulsed Dppler mdalities shuld be carried ut. The inferir vena cava, renal and intra renal veins are t be evaluated s that the presence and extent f disease can be dcumented. Imaging: The study shuld dcument vessel and rgan anatmy and mrphlgy with high quality imaging. Renal size and the dcumentatin f the parenchyma is an imprtant part f this study. Haemdynamics: The study dcuments vessel haemdynamics by sampling f the apprpriate vessels. Velcity determinatins are made with knwledge f the angle between the ultrasund beam and the vessel being examined. Velcity r frequency measurements and spectral wavefrm characteristics are recrded at representative sites within the vessels. Page 4 f 6 01/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W ACN ABN ISO 9001 certified by BSI under Certificate N. FS

5 Evaluatin f renal transplants Examinatin f the renal parenchyma is an essential part f the examinatin with the ple t ple length being measured. A thrugh examinatin f the transplant artery/ies and vein/s within the renal circulatin using B-mde imaging, clur Dppler imaging and pulsed Dppler mdalities shuld be carried ut. The curse f the abdminal arta, ipsilateral iliac arteries and intra renal arteries are t be evaluated s that the presence and extent f disease can be dcumented. Imaging: The study shuld dcument vessel anatmy and mrphlgy with high quality imaging. Haemdynamics: The study dcuments vessel haemdynamics by sampling f the apprpriate vessels. Velcity determinatins are made with knwledge f the angle between the ultrasund beam and the vessel being examined. Velcity r frequency measurements and spectral wavefrm characteristics are recrded at representative sites within the vessels. Evaluatin f liver transplants Imaging: The study shuld dcument vessel anatmy and mrphlgy with high quality imaging. Haemdynamics: The study dcuments vessel haemdynamics by sampling f the apprpriate vessels. Velcity determinatins are made with knwledge f the angle between the ultrasund beam and the vessel being examined. Velcity r frequency measurements and spectral wavefrm characteristics are recrded at representative sites within the vessels. Sectin 3: Diagnstic Criteria Accepted diagnstic criteria are used t assess the presence and severity f abnrmality in the intra-abdminal and retrperitneal circulatin. The primary purpse f the duplex examinatin is t determine the presence r absence f disease in the intra-abdminal and retrperitneal circulatin, and if disease is present, t dcument its nature, lcatin, extent and severity. Imaging: The image prvides anatmical infrmatin abut the lcatin and rientatin f vessels as well as the presence f abnrmalities. Interpretatin f B-mde data shuld include anatmic infrmatin abut the lcatin and rientatin f the abdminal vasculature and abdminal rgans. Limitatins in image quality and cmpleteness f the examinatin shuld be nted. Haemdynamics: Vessel haemdynamics assessed by Dppler ultrasund (and clur Dppler imaging) shuld be categrised accrding t the presence r absence f flw (cclusin) and the severity f stensis. Velcity determinatins are made with knwledge f the angle between the ultrasund beam and the vessel being examined. A detailed descriptin f the diagnstic criteria used fr each examinatin shuld be able t be prvided. This shuld accmpany any charts, graphics r frmulae used in the interpretatin f the examinatin results. Specific references, including text r article, authr, date, name and vlume number f jurnal, r name f text and publisher shuld be prvided. Diagnstic criteria that have been develped within the vascular practice r mdified frm standard published criteria shuld be internally validated where pssible. Page 5 f 6 01/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W ACN ABN ISO 9001 certified by BSI under Certificate N. FS

6 Sectin 4: Summary Once the clinical indicatins fr the examinatin have been elicited frm the patient and the sngrapher has addressed any questins r cncerns raised by the patient, the examinatin can cmmence after infrmed cnsent has been btained frm the patient. A cmplete and thrugh examinatin shuld be perfrmed (using the guidelines abve) and extended as necessary. Adequate, representative hard cpy shuld be made f all aspects f the examinatin, including a written wrksheet fr the reprting physician. Page 6 f 6 01/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W ACN ABN ISO 9001 certified by BSI under Certificate N. FS