Lower Extremity Arterial Doppler
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1 Lower Extremity Arterial Doppler 1. Spectral Doppler waveform should be taken in distal aorta and common iliac arteries. 2. R/L common femoral artery (CFA) color Doppler with velocity and B-mode. 3. R/L proximal profunda color Doppler with velocity and B-mode. 4. R/L superficial femoral artery (SFA) color Doppler with velocity and B-mode. Obtain at three locations within SFA prox, mid, dist. 5. R/L popliteal artery (POP A) color Doppler with velocity and B-mode. 6. R/L posterior tibial artery (PTA), anterior tibial artery (ATA) Doppler with velocity and B- mode. Attempt to obtain waveform in peroneal and dorsalis pedis (DP) artery.
2 Lower Extremity SONOGRAPHER NOTES INDICATIONS DATE/TIME SONOGRAPHER Aorta PVS RIGHT Waveform (circle one) Velocity Comments Common iliac artery Monophasic Biphasic Triphasic CFA Monophasic Biphasic Triphasic Profunda Monophasic Biphasic Triphasic SFA Prox Monophasic Biphasic Triphasic SFA Mid Monophasic Biphasic Triphasic SFA Distal Monophasic Biphasic Triphasic POP A Monophasic Biphasic Triphasic PTA Monophasic Biphasic Triphasic ATA Monophasic Biphasic Triphasic LEFT Waveform (circle one) Velocity Common iliac artery Monophasic Biphasic Triphasic CFA Monophasic Biphasic Triphasic Profunda Monophasic Biphasic Triphasic SFA Prox Monophasic Biphasic Triphasic SFA Mid Monophasic Biphasic Triphasic SFA Distal Monophasic Biphasic Triphasic POP A Monophasic Biphasic Triphasic PTA Monophasic Biphasic Triphasic ATA Monophasic Biphasic Triphasic Iliac artery Monophasic Biphasic Triphasic SONOGRAPHER CONFIRMATION: My signature confirms that instructions have been provided to the conscious patient regarding this exam, that US utilizes sound waves rather than ionizing radiation, and that coupling gel is used to improve the quality of the exam. Sonographer s Signature FMC KMC CMC TMC NHSC Name / MR # / Label KIC MIC PI TI MFP SFP Other US Lower Extremity
3 Upper Extremity Arterial Doppler B-mode and Doppler with spectral analysis with velocity measurements in the following areas: 1. R/L subclavian artery 2. R/L axillary artery 3. R/L brachial arteries 4. R/L radial and ulnar arteries Additional imaging of stenosis areas should be evaluated with spectral imaging proximal and distal to stenosis
4 INDICATIONS Upper Extremity DATE/TIME SONOGRAPHER NOTES SONOGRAPHER RIGHT Waveform (circle one) Velocity Subclavian Monophasic Biphasic Triphasic Axillary Monophasic Biphasic Triphasic Brachial Monophasic Biphasic Triphasic Radial Monophasic Biphasic Triphasic Ulnar Monophasic Biphasic Triphasic LEFT Waveform (circle one) Velocity Subclavian Monophasic Biphasic Triphasic Axillary Monophasic Biphasic Triphasic Brachial Monophasic Biphasic Triphasic Radial Monophasic Biphasic Triphasic Ulnar Monophasic Biphasic Triphasic Comments SONOGRAPHER CONFIRMATION: My signature confirms that instructions have been provided to the conscious patient regarding this exam, that US utilizes sound waves rather than ionizing radiation, and that coupling gel is used to improve the quality of the exam. Sonographer s Signature FMC KMC CMC TMC NHSC Name / MR # / Label KIC MIC PI TI MFP SFP Other US Upper Extremity
5 Pseudoaneurysm 1. Image common femoral artery (CFA), superficial femoral artery (SFA), common femoral vein (CFV), and greater saphenous vein (GSV) long with color Doppler and velocity measurements. 2. If pseudoaneurysm found, image in trans with B-mode and measure diameter in AP and left-to-right. Color Doppler image of pseudo and waveform in pseudo and neck area. 3. Image pseudo in long with B-mode measuring superior-to-inferior, and color Doppler of pseudo and neck. Document with B-mode, color Doppler, and waveforms any AV fistulas.
6 Graft Evaluations Evaluate entire graft record images with color Doppler and velocities at: Proximal anastomosis (PROX ANAST), Proximal graft (PROX GRAFT), Middle graft (MID GRAFT), Distal graft (DIST GRAFT), and Distal anastomosis (DIST ANAST). Also interrogate native artery proximal and distal to anastomosis. Record color Doppler velocities proximal, at, and distal to any stenosis. Measure graft diameter at each of three sites in graft. Interpretation of Findings Waveform Normal in early postoperative period (up to 3-6 weeks) = Low resistance pattern (forward diastolic flow) Normal after 3-6 weeks = High resistance pattern (triphasic waveform) Peak Flow Velocity Less than 45 ec = Abnormal Indicative of impending graft failure. Patient needs angio and/or revision. Greater than 45 ec and less than 120 ec = Normal Greater than 120 ec throughout graft = Normal Usually seen in early postoperative period when saphenous vein graft exceptionally small (less than 4 mm) and therefore flow restrictive Focal = Abnormal Indicative of a focal stenosis Should be associated with spectral broadening. Velocity greater than 120 ec associated with at least 50% diameter stenosis.
7 Graft Evaluations Worksheet SONOGRAPHER NOTES INDICATIONS DATE/TIME SONOGRAPHER ARTERY PROXIMAL TO ANASTAMOSIS WITHIN GRAFT PROX MID DIST ARTERIAL OR VENOUS FLOW DISTAL TO ANASTAMOSIS Comments SONOGRAPHER CONFIRMATION: My signature confirms that instructions have been provided to the conscious patient regarding this exam, that US utilizes sound waves rather than ionizing radiation, and that coupling gel is used to improve the quality of the exam. Sonographer s Signature FMC KMC CMC TMC NHSC Name / MR # / Label KIC MIC PI TI MFP SFP Other US Graft Evaluations Worksheet
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Case #1. Case #1- Possible codes. Unraveling the -59 modifier. Principles of Interventional. CASE 1: Simple angioplasty
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PUT YOUR BEST FOOT FORWARD
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Functional anatomy and variability of the blood vessels of the upper and lower limbs. Anastasia Bendelic Human Anatomy Departament
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