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PeripheralVascularUltrasound The2ndaffiliatedHosp ofGZMULuoYanHua1060240 Theanatomyoftheperipheralvascular1 ThearterialanatomyoftheupperlimbSubclavianartery Axillaryartery BrachialarteryRadialartery Ulnarartery Theanatomyoftheperipheralvascular2 ThearterialanatomyofthelowerlimbCommonfemoralartery Superficialfemoralartery Profundafemorisartery Poplitealartery Anteriortibialartery Posteriortibialartery Tibioperonealtrunk Peronealartery Dorsalispedisartery Thearterialanatomyofthelowerlimb Theanatomyoftheperipheralveins1 Theupperlimbvenoussystemcanbedividedintothedeepandsuperficialveins Themaindeepveinsoftheupperlimb Radialvein Ulnarvein Brachialvein Axillaryvein Subclavianvein TheanatomyoftheperipheralveinsThemainsuperficialveinsoftheupperlimb Cephalicvein Basilicvein Mediancubitalvein Theanatomyoftheperipheralveins2 Themaindeepveinsofthelowerlimb Anteriortibialveins Posteriortibialveins Peronealveins Poplitealvein Superficialfemoralvein Profundafemorisvein Commonfemoralvein TheanatomyoftheperipheralveinsThemainsuperficialveinsinthelowerlimbsarethelongsaphenousvein LSV andshortsaphenousvein SSV Theanatomyoftheperipheralveins3 Veinscontainvalvestopreventtherefluxofbloodtotheextremities Venousvalvesarebicuspid TechnicalAspects1 Patientpreparation Don tneedpreparation 2 Patientposition insupineanderectposition prone thelimbissupinatedandslightlyabducted TechnicalAspects3 EquipmentrequirementAhigh capacityscanconvertertheupperlimb 5 10MHzthelowerlimb 5 7MHz4 Methods longitudinalscanplaneandtransverseplane Don tabductedstrongly astheveinscanbecompressed Normalperipheralartery1 B modeimages thelumenofanormalperipheralarteryshouldappearclear andthewallsshouldbeuniformalongeacharterialsegment AlongitudinalB modeimageofthesuperficialfemoralartery profundafemorisartery 2 Colorflowimages Thereshouldbecolorfillingtothevesselwalls Alongitudinalcolorflowimageofthecommonfemoralartery Atransversecolorflowimageofthecommonfemoralartery 3 SpectralDoppler Thenormalspectraldopplerdisplaydemonstratesatriphasicflowpatternwithaclearspectralwindow Inelderlypatientsorpatientswithpoorcardiacoutput thewaveformmaybebiphasicorevenmonophonic Normalperipheralvein1 B modeimages Theveinshouldappearclearandcontainnoechoes Theveincanbecompressed Normalperipheralvein2 Colorflowimages Spontaneousphasicflowisusuallyseeninthelargerveins Thereshouldbecompletecolorfillingofthelumeninbothlongitudinalandtransverseplanesduringacalfsqueeze Anteriortibialveins Normalperipheralvein3 SpectralDoppler TheDopplersignalatthelevelofthecommonfemoralveinshouldexhibitaspontaneousphasicflowpattern whichtemporarilyceaseswhenthepatientperformsaValsalvamaneuver spectraldopplerofthesuperficialfemoralvein thepatienttakesadeepinspirationorperformsaValsalvamaneuver spectraldopplerofpoplitealvein atrest AtherosclerosisTheearliestultrasoundsignisthickeningoftheintimaandmedia 1 0mm inthebifurcation 1 2mm AtherosclerosisAtheroma theintimaandmedia 1 5mm Multileveldiseaseandbilateralinvolvementarecommon L CFA R CFA Atherosclerosis2 Colorflowimages Flowsignalschangetobefineordefect Arterialstenoseswillbedemonstratedasareasofcolorflowdisturbanceoraliasing Anocclusionisdemonstratedbyatotalabsenceofcolorflowinthevessel Atherosclerosis3 SpectralDoppler Ifthearteryisnosignificantstenosis spectraldopplerisnormal Inthepresenceofasignificantstenosis therewillbeanincreaseinflowvelocityacrossthelesionassociatedwithspectralbroadeningandturbulencejustdistaltothelesion TrueaneurysmB modeimages Thearteryappearsabnormallyenlarged thelesiondiameteris1 5timesmorethantheadjacentnormaldiameter walloftheaneurysmisarterywall TrueaneurysmB modeimages Theshapeoftheaneurysmcanvary youcouldfoundhypoechoicthrombosisintheaneurysm B modeimagingisusedtoassessthesize lengthandamountofthrombuswithintheaneurysm Trueaneurysm2 Colorflowimages SpectralDoppler trueaneurysmwillbeseencolorflowdisorder FalseaneurysmsFalseaneurysms alsoknownaspseudo aneurysms primarilyoccurfollowingarterialpunctureforcatheteraccess duetopoorcontrolofarterialbleedingfollowingtheprocedure Falseaneurysms1 Bloodflowbackwardandforwardthroughaholeinthearterialwallintothesurroundingtissue formingaflowcavityinthetissueadjacenttotheartery Thefalselumenoftencontainsthrombus Falseaneurysmscanincreaseinsizeovertime Falseaneurysms2 Colorflowimages Thecolorflowimagetypicallydemonstratesahigh velocityjetoriginatingfromthedefectinthearterywall whichisassociatedwithaswirlingpatterninsidethefalselumen similartothe yin yang sign Falseaneurysms3 SpectralDoppler SpectralDopplerusuallydemonstratesanequalforwardflowandreverseflowcomponenttothearterialjetasflowentersthefalseaneurysmduringsystoleandexitsduringdiastole yin yang sign DissectinganeurysmsOccurduetoadisruptionoftheintimalliningofthevessel allowingbloodtoenterthesubintimalspace Thiscanresultinthestrippingoftheintima andsometimesofthemedia fromthearterywall Dissectinganeurysms1 B modeimages afalseflowlumeniscreatedandthedissectedlayerofintimaandmediamaybeseenflappingfreelyintimewitharterialpulsation Dissectinganeurysms2 Colorflowimages Antidiastole Thromboangiitisobliterans TO1 Clinical Ofteninvolvingthesmallandmedium sizedarteryandaccompanyingvein segmentaldistribution morecommoninmales smokers 20 40yearold Thromboangiitisobliterans TOB modeimages Roughintimal vascularwalluneventhickening theinsidediameterofthearterydecreased oftenbelowthepoplitealartery Thromboangiitisobliterans TOColorflowimages Flowsignalschangedtobefine defectordot like ifcompleteocclusion noflowsignalintheartery Thromboangiitisobliterans TO4 SpectralDoppler VariationMildlesions atriphasicflowpatternwithaclearspectralwindow mostcases thewaveformmaybemonophonic completeocclusion nowaveformcanbefound male 56Ythromboangiitisobliteransintheleftanteriortibialartery male 56Ythromboangiitisobliteransintheleftanteriortibialartery male 56Ythromboangiitisobliteransintheleftanteriortibialartery Takayasu sarteritis TA1 Clinical Ofteninvolvingtheaortaanditsbranches chronicnon specificinflammation morecommoninyoungwomen Arterialwallstiffness calcificationandatrophy adhesionwithsurroundingtissue stenosisorocclusion2 B modeimage Morethantwovesselsaffected vascularwalluneventhickening Unevenecho stenosisorocclusion Colorflowimages Notseverestenosis bloodflowinasinglecolor Withtheincreasingdegreesofthestenosis flowsignalschangedtobefine noflowsignalscanbefoundinocclusion SpectralDoppler VariationDiffuselesions thewaveformmaybemonophonic lowspeedflowspectrum Localstenosis highspeedflowspectrum Occlusion nowaveformcanbefound Thewallofcommoncarotidarterythickening butintimaisstillsmooth thelumenisnarrowing Thewallofcommoncarotidarterythickening lumenisobviouslysmaller Colorflowimages Thelumenisnarrowing Bloodvelocityincreased SpectralDopplerofsubclavianartery thelumenisnarrowing bloodvelocityincreased near4m s Extremityvenousthrombosis1 B modeimages Inthepresenceofthrombustheveinwillnotcompress Intheveryearlystagesofthrombosis theclotoftenhasadegreeofechogenicity Within1or2days theclotbecomesmoreanechoic itisoftenpossibletoseesubtleechoes Iftheveinistotallyoccludedintheacutephase itmayappeardistended Olderthrombus beyondtwoweeksinage becomesmoreechogenic AlongitudinalB modeimageofacommonfemoralveinthrombosis AtransverseB modeimageofaperonealveinthrombosis Extremityvenousthrombosis2 Colorflowimages Thereisanabsenceofcolorfillinginoccludedveins evenwithdistalaugmentation Thiscanbedemonstratedinbothlongitudinalandtransversesections Alongitudinalcolorimageofasuperficialfemoralveinthrombosis Atransversecolorimageofasuperficialfemoralveinthrombosis Acolorflowimageofsuperficialfemoralvein Flowisseenbetweenthethrombusandveinwall Extremityvenousthrombosis3 SpectralDoppler ThereisanabsenceofaspectralDopplersignalwhentheveiniscompletelyoccluded Whentheveincontainsasignificantamountofpartiallyoccludingorfree floatingthrombus thereisnormallyareducedflowpattern whichdemonstrateslittleornoaug