下肢血管-英文.ppt

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：Dontneedpreparation.2.Patientposition:insupineanderectposition,prone.thelimbissupinatedandslightlyabducted.,TechnicalAspects3.EquipmentrequirementAhigh-capacityscanconvertertheupperlimb:510MHzthelowerlimb:57MHz4.Methods：longitudinalscanplaneandtransverseplane.,Dontabductedstrongly,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.Colorflowimagesifcompleteocclusion,noflowsignalintheartery.,Thromboangiitisobliterans,TO4.SpectralDoppler:VariationMildlesions:atriphasicflowpatternwithaclearspectralwindow;mostcases:thewaveformmaybemonophonic；completeocclusion:nowaveformcanbefound.,male,56Ythromboangiitisobliteransintheleftanteriortibialartery,male,56Ythromboangiitisobliteransintheleftanteriortibialartery,male,56Ythromboangiitisobliteransintheleftanteriortibialartery,Takayasusarteritis,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,whichdemonstrateslittleornoaugmentationfollowingdistalcompression.,VenousvalvularincompetenceDuringValsalvatesting,iftherehasrefluxacrossthevein,morethan1s,weca