Introduction History Preceded by Arterial Doppler and ABI Indications
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1 Elise Brady, RVT, RDMS
2 Introduction History Preceded by Arterial Doppler and ABI Indications
3 1) Abnormal ABI (within 2weeks of duplex) 2) Abnormal Doppler waveforms 3) Claudication 4) History of PVD 5) Follow-up for PTA, stent, graft or disease
4 PROCEDURE Colorflow and Doppler imaging with velocity measurements Images should include these arteries 1. Common Femoral 2. Profunda 3. Femoral (prox, mid, dist) 4. Popliteal 5. Proximal posterior tibial (optional) 6. Proximal peroneal (optional)( p
5 Include Images of Stenosis Stent Graft
6 This is very important for optimal colorflow images of high h and low flow states t Assume velocity range from cm/sec. Color scale is proportional p to velocity, as velocities go up, bring scale up Start at CFA, bring color scale down until you see color aliasing, then move back up one range. Adjust color gain for good vessel fill, but not overwriting the 2D. Color should stay inside the vessel. Remember to readjust the color scale with big changes in the velocities. ie; high grade stenosis or collateral flow My suggestion is to practice adjusting color scale and gain while you are scanning patients
7 1. Get colorflow and Doppler at the highest velocity, y, and p prox and distal to stenosis 2. Doubling of velocity = greater than 50% stenosis 3. Less than doubling = less than 50% stenosis p colorflow to visualize jjets,, color 4. Optimize bruits and PST g of stenosis or occlusion 5. Measure length
8 1. No Doppler signal 2. Watch for heavy calcification 3. Look for Collaterals 4. Scan transverse to look for color
9 Grafts- Include inflow vessel, prox anastamosis, survey graft, mid graft, dist. anastamosis and outflow vessel 1) Look for scars and scan transverse to identify graft 2) Most common grafts are fem-pop, usually arterialized GSV, Fem-fem and aorto-ilio Y graft. Stents- get pre-stent, mid stent, and post stent duplex images, look for cross Weave pattern. Can be seen by scanning medial to lateral Stents are great way to open arteries without surgery Especially good for focal stenosis, limb salvage and pt s that are not candidates for bypass surgery They are permanent, do regular follow-up s to find stenosist i before occlusion
10 Normal peripheral arteries are high resistant waveforms, good upstroke and usually multiphasic. Multiphasic accepted term for both tri and biphasic 1. Too much confusion over bi and triphasic 2. Pulsed wave doesn't always show 3 rd phase 3. Less than ideal angle of cw probe Monophasic 4. Calcified vessels reduce elasticity, thus decreasing flow reversal 5. Less than 30 cm/sec is usually collateral flow from proximal occlusion 6. Good amplitude and velocity can come from good collaterals
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12 Stenosis or Occlusion (Peak systolic velocity ratio) 1. Velocities doubling of velocity and PSVR > 2.0 = >50% stenosis Tripling of velocity and PSVR > 3.0= >75% stenosis PSVR of > 4.0 = Critical stenosis No need to subdivide 50-75% stenosis, >50% stenosis will induce claudication 2. Colorflow was there color changes? 3. DFA is collateral pathway, may see elevation 3. DFA is collateral pathway, may see elevation without stenosis
13 Diffuse vs. Focal Disease 1. Focal- small areas of stenosis and occlusion 2. Diffuse multiple l areas of stenosisand/or long areas of occlusion Degree of Insufficiency or Disease 1. Distal Vessels look at velocity and waveforms 2. < cm/sec is usually collateral flow. QA done showed arteriogram with occlusion with duplex showing low flow 3. Compare velocities side by side and look for global effects, caused by cardiac output, diffuse and calcified vessels.
14 Stents 1. PSV > 190 cm/sec and PSVR > 1.5 = > 50% instent stenosis 2. PSV > 275 cm/sec and PSVR > 3.5 = > 80% instent stenosis 3. It is better to do intervention at stenosis than risk occlusion Grafts 1. PSV > 300 cm/sec, PSVR > 3.5 and mid graft velocity of < 45 cm/sec = high risk of impending graft failure 2. It s better to do a graft revision of stenosis, than replace the graft once it occludes SVU interpretation t ti course 2009, and journal articles
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16 Artery Velocity cm/sec External Iliac 120(+22) Common Femoral 114 (+14) Femoral 92 (+14) Popliteal l 69 (+13)
17 Case Study 1
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20
21 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
22 o open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
23 o open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
24 to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
25 mputer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
26 Case Study 2
27 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
28 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
29 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
30 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
31 ve enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
32
33 age may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Lt. SFA Proximal
34 o open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
35 memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
36 Exams Codes Lower extremity arterial duplex-complete Lower extremity arterial duplex-limited Lower extremity arterial Doppler-single level Lower extremity arterial Doppler-multilevel 93923
37 Unspecified Peripheral Vascular Disease Claudication Rest Pain Ulceration
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