下肢血管-英文ppt课件

.,1,PeripheralVascularUltrasound,The2ndaffiliatedHosp.ofGZMULuoYanHua1060240,.,2,Theanatomyoftheperipheralvascular1.ThearterialanatomyoftheupperlimbSubclavianartery,Axillaryartery,BrachialarteryRadialartery,Ulnarartery.,.,3,Theanatomyoftheperipheralvascular2.ThearterialanatomyofthelowerlimbCommonfemoralartery,Superficialfemoralartery,Profundafemorisartery,Poplitealartery,Anteriortibialartery,Posteriortibialartery,Tibioperonealtrunk,Peronealartery,Dorsalispedisartery.,.,4,Thearterialanatomyofthelowerlimb,.,5,Theanatomyoftheperipheralveins1.Theupperlimbvenoussystemcanbedividedintothedeepandsuperficialveins.Themaindeepveinsoftheupperlimb:Radialvein,Ulnarvein,Brachialvein,Axillaryvein,Subclavianvein.,.,6,TheanatomyoftheperipheralveinsThemainsuperficialveinsoftheupperlimb:Cephalicvein,Basilicvein,Mediancubitalvein.,.,7,Theanatomyoftheperipheralveins2.Themaindeepveinsofthelowerlimb:Anteriortibialveins,Posteriortibialveins,Peronealveins,Poplitealvein,Superficialfemoralvein,Profundafemorisvein,Commonfemoralvein.,.,8,.,9,TheanatomyoftheperipheralveinsThemainsuperficialveinsinthelowerlimbsarethelongsaphenousvein(LSV)andshortsaphenousvein(SSV).,.,10,Theanatomyoftheperipheralveins3.Veinscontainvalvestopreventtherefluxofbloodtotheextremities.Venousvalvesarebicuspid.,.,11,TechnicalAspects1.Patientpreparation：Dontneedpreparation.2.Patientposition:insupineanderectposition,prone.thelimbissupinatedandslightlyabducted.,.,12,.,13,.,14,.,15,TechnicalAspects3.EquipmentrequirementAhigh-capacityscanconvertertheupperlimb:510MHzthelowerlimb:57MHz4.Methods：longitudinalscanplaneandtransverseplane.,Dontabductedstrongly,astheveinscanbecompressed.,.,16,Normalperipheralartery1.B-modeimages:thelumenofanormalperipheralarteryshouldappearclear,andthewallsshouldbeuniformalongeacharterialsegment.,.,17,AlongitudinalB-modeimageofthesuperficialfemoralartery,profundafemorisartery,.,18,2.Colorflowimages：Thereshouldbecolorfillingtothevesselwalls.,.,19,Alongitudinalcolorflowimageofthecommonfemoralartery,.,20,Atransversecolorflowimageofthecommonfemoralartery,.,21,3.SpectralDoppler：Thenormalspectraldopplerdisplaydemonstratesatriphasicflowpatternwithaclearspectralwindow.Inelderlypatientsorpatientswithpoorcardiacoutput,thewaveformmaybebiphasicorevenmonophonic.,.,22,.,23,Normalperipheralvein1.B-modeimages:Theveinshouldappearclearandcontainnoechoes.Theveincanbecompressed.,.,24,.,25,Normalperipheralvein2.Colorflowimages:Spontaneousphasicflowisusuallyseeninthelargerveins.Thereshouldbecompletecolorfillingofthelumeninbothlongitudinalandtransverseplanesduringacalfsqueeze.,.,26,.,27,Anteriortibialveins,.,28,Normalperipheralvein3.SpectralDoppler:TheDopplersignalatthelevelofthecommonfemoralveinshouldexhibitaspontaneousphasicflowpattern,whichtemporarilyceaseswhenthepatientperformsaValsalvamaneuver.,.,29,spectraldopplerofthesuperficialfemoralvein,.,30,thepatienttakesadeepinspirationorperformsaValsalvamaneuver,.,31,spectraldopplerofpoplitealvein,atrest,.,32,.,33,.,34,AtherosclerosisTheearliestultrasoundsignisthickeningoftheintimaandmedia(1.0mm),inthebifurcation(1.2mm),.,35,AtherosclerosisAtheroma：theintimaandmedia(1.5mm)Multileveldiseaseandbilateralinvolvementarecommon.,L-CFA,R-CFA,.,36,Atherosclerosis2.Colorflowimages：Flowsignalschangetobefineordefect.Arterialstenoseswillbedemonstratedasareasofcolorflowdisturbanceoraliasing.Anocclusionisdemonstratedbyatotalabsenceofcolorflowinthevessel.,.,37,Atherosclerosis3.SpectralDoppler：Ifthearteryisnosignificantstenosis,spectraldopplerisnormal.Inthepresenceofasignificantstenosis,therewillbeanincreaseinflowvelocityacrossthelesionassociatedwithspectralbroadeningandturbulencejustdistaltothelesion.,.,38,.,39,.,40,.,41,.,42,.,43,.,44,.,45,.,46,TrueaneurysmB-modeimages：Thearteryappearsabnormallyenlarged,thelesiondiameteris1.5timesmorethantheadjacentnormaldiameter,walloftheaneurysmisarterywall.,.,47,.,48,TrueaneurysmB-modeimages：Theshapeoftheaneurysmcanvary,youcouldfoundhypoechoicthrombosisintheaneurysm.B-modeimagingisusedtoassessthesize,lengthandamountofthrombuswithintheaneurysm.,.,49,.,50,Trueaneurysm2.Colorflowimagesifcompleteocclusion,noflowsignalintheartery.,.,69,Thromboangiitisobliterans,TO4.SpectralDoppler:VariationMildlesions:atriphasicflowpatternwithaclearspectralwindow;mostcases:thewaveformmaybemonophonic；completeocclusion:nowaveformcanbefound.,.,70,male,56Ythromboangiitisobliteransintheleftanteriortibialartery,.,71,male,56Ythromboangiitisobliteransintheleftanteriortibialartery,.,72,male,56Ythromboangiitisobliteransintheleftanteriortibialartery,.,73,Takayasusarteritis,TA1.Clinical:Ofteninvolvingtheaortaanditsbranches,chronicnon-specificinflammation,morecommoninyoungwomen.Arterialwallstiffness,calcificationandatrophy,adhesionwithsurroundingtissue,stenosisorocclusion2.B-modeimage:Morethantwovesselsaffected；vascularwalluneventhickening,Unevenecho,stenosisorocclusion.,.,74,Colorflowimages:Notseverestenosis,bloodflowinasinglecolor;Withtheincreasingdegreesofthestenosis,flowsignalschangedtobefine;noflowsignalscanbefoundinocclusion.SpectralDoppler:VariationDiffuselesions:thewaveformmaybemonophonic，lowspeedflowspectrum;Localstenosis:highspeedflowspectrum;Occlusion:nowaveformcanbefound.,.,75,Thewallofcommoncarotidarterythickening,butintimaisstillsmooth,thelumenisnarrowing.,.,76,Thewallofcommoncarotidarterythickening,lumenisobviouslysmaller.,.,77,Colorflowimages:Thelumenisnarrowing.,.,78,.,79,Bloodvelocityincreased.,.,80,SpectralDopplerofsubclavianartery,thelumenisnarrowing,bloodvelocityincreased,near4m/s.,.,81,Extremityvenousthrombosis1.B-modeimages:Inthepresenceofthrombustheveinwillnotcompress.Intheveryearlystagesofthrombosis,theclotoftenhasadegreeofechogenicity.Within1or2days,theclotbecomesmoreanechoic.itisoftenpossibletoseesubtleechoes.Iftheveinistotallyoccludedintheacutephase,itmayappeardistended.Olderthrombus,beyondtwoweeksinage,becomesmoreechogenic.,.,82,AlongitudinalB-modeimageofacommonfemoralveinthrombosis,.,83,AtransverseB-modeimageofaperonealveinthrombosis,.,84,.,85,Extremityvenousthrombosis2.Colorflowimages:Thereisanabsenceofcolorfillinginoccludedveins,evenwithdistalaugmentation.Thiscanbedemonstratedinbothlongitudinalandtransversesections.,.,86,Alongitudinalcolorimageofasuperficialfemoralveinthrombosis,.,87,Atransversecolorimageofasuperficialfemoralveinthrombosis,.,88,Acolorflowimageofsuperficialfemoralvein.Flowisseenbetweenthethrombusandveinwall.,.,89,Extremityvenousthrombosis3.SpectralDoppler:ThereisanabsenceofaspectralDopplersignalwhentheveiniscompletelyoccluded.Whentheveincontainsasignificantamountofpartiallyoccludingorfree-floatingthrombus,thereisnormallyareducedflowpattern,whichdemonstrateslittleornoaugmentationfollowingdistalcompression.,.,90,.,91,VenousvalvularincompetenceDuringValsalvatesting,iftherehasrefluxacrossthevein,morethan1s,wecallthis