下肢血管-英文

1、Peripheral Vascular Ultrasound1The anatomy of the peripheral vascular1. The arterial anatomy of the upper limbSubclavian artery,Axillary artery,Brachial arteryRadial artery,Ulnar artery.2The anatomy of the peripheral vascular2. The arterial anatomy of the lower limbCommon femoral artery, Superficial

2、 femoral artery,Profunda femoris artery,Popliteal artery, Anterior tibial artery, Posterior tibial artery, Tibioperoneal trunk,Peroneal artery, Dorsalis pedis artery.3The arterial anatomy of the lower limb4The anatomy of the peripheral veins1. The upper limb venous system can be divided into the dee

3、p and superficial veins.The main deep veins of the upper limb: Radial vein,Ulnar vein, Brachial vein,Axillary vein, Subclavian vein.5The anatomy of the peripheral veins The main superficial veins of the upper limb: Cephalic vein, Basilic vein, Median cubital vein.6The anatomy of the peripheral veins

4、2. The main deep veins of the lower limb:Anterior tibial veins, Posterior tibial veins, Peroneal veins, Popliteal vein, Superficial femoral vein, Profunda femoris vein,Common femoral vein.78 The anatomy of the peripheral veins The main superficial veins in the lower limbs are the long saphenous vein

5、 (LSV) and short saphenous vein (SSV).9The anatomy of the peripheral veins 3. Veins contain valves to prevent the reflux of blood to the extremities. Venous valves are bicuspid.10Technical Aspects1. Patient preparation：Dont need preparation.2. Patient position: in supine and erect position, prone.th

6、e limb is supinated and slightly abducted.11121314Technical Aspects3. Equipment requirement A high-capacity scan converter the upper limb: 510MHz the lower limb: 57MHz 4. Methods：longitudinal scan plane and transverse plane.Dont abducted strongly, as the veins can be compressed.15Normal peripheral a

7、rtery1.B-mode images: the lumen of a normal peripheral artery should appear clear, and the walls should be uniform along each arterial segment.16A longitudinal B-mode image of the superficial femoral artery, profunda femoris artery172. Color flow images：There should be color filling to the vessel wa

8、lls.18A longitudinal color flow image of the common femoral artery19A transverse color flow image of the common femoral artery203. Spectral Doppler： The normal spectral doppler display demonstrates a triphasic flow pattern with a clear spectral window. In elderly patients or patients with poor cardi

9、ac output, the wave form may be biphasic or even monophonic.2122Normal peripheral vein1. B-mode images: The vein should appear clear and contain no echoes. The vein can be compressed.2324Normal peripheral vein2. Color flow images: Spontaneous phasic flow is usually seen in the larger veins. There sh

10、ould be complete color filling of the lumen in both longitudinal and transverse planes during a calf squeeze. 2526Anterior tibial veins27Normal peripheral vein3. Spectral Doppler: The Doppler signal at the level of the common femoral vein should exhibit a spontaneous phasic flow pattern, which tempo

11、rarily ceases when the patient performs a Valsalva maneuver. 28spectral doppler of the superficial femoral vein29the patient takes a deep inspiration or performs a Valsalva maneuver 30spectral doppler of popliteal vein, at rest313233AtherosclerosisThe earliest ultrasound sign is thickening of the in

12、tima and media (1.0mm) , in the bifurcation (1.2mm)34Atherosclerosis Atheroma：the intima and media (1.5mm) Multilevel disease and bilateral involvement are common.L-CFAR-CFA35Atherosclerosis2. Color flow images：Flow signals change to be fine or defect.Arterial stenoses will be demonstrated as areas

13、of color flow disturbance or aliasing. An occlusion is demonstrated by a total absence of color flow in the vessel. 36Atherosclerosis3. Spectral Doppler：If the artery is no significant stenosis, spectral doppler is normal. In the presence of a significant stenosis, there will be an increase in flow

14、velocity across the lesion associated with spectral broadening and turbulence just distal to the lesion.373839404142434445True aneurysmB-mode images： The artery appears abnormally enlarged, the lesion diameter is 1.5 times more than the adjacent normal diameter, wall of the aneurysm is artery wall .

15、4647True aneurysmB-mode images：The shape of the aneurysm can vary, you could found hypoechoic thrombosis in the aneurysm.B-mode imaging is used to assess the size, length and amount of thrombus within the aneurysm.4849True aneurysm2. Color flow images & Spectral Doppler： true aneurysm will be seen c

16、olor flow disorder.50 False aneurysms False aneurysms, also known as pseudo-aneurysms, primarily occur following arterial puncture for catheter access, due to poor control of arterial bleeding following the procedure.51False aneurysms 1. Blood flow backward and forward through a hole in the arterial

17、 wall into the surrounding tissue, forming a flow cavity in the tissue adjacent to the artery. The false lumen often contains thrombus, False aneurysms can increase in size over time.52False aneurysms 2. Color flow images ：The color flow image typically demonstrates a high-velocity jet originating f

18、rom the defect in the artery wall, which is associated with a swirling pattern inside the false lumen, similar to the yin-yang sign.53False aneurysms 3. Spectral Doppler：Spectral Doppler usually demonstrates an equal forward flow and reverse flow component to the arterial jet as flow enters the fals

19、e aneurysm during systole and exits during diastole.54555657yin-yang sign585960Dissecting aneurysmsOccur due to a disruption of the intimallining of the vessel, allowing blood to enter the subintimal space. This can result in the stripping of the intima, and sometimes of the media, from the artery w

20、all. 61Dissecting aneurysms1. B-mode images: a false flow lumen is created and the dissected layer of intima and media may be seen flapping freely in time with arterial pulsation.6263Dissecting aneurysms2. Color flow images 64Ture aneurysm False aneurysms Dissecting aneurysmscauseatherosclerosisinju

21、ry, infectionatherosclerosis, marfan syndromeB-mode imagesthe artery enlargearteria cystic massa ture lumen and a false lumenwall of the aneurysmarterial wallsurrounding tissuecolor flow images disturbanceyin-yang signcolor flow in ture lumen and false lumen in different directionsAntidiastole65Thro

22、mboangiitis obliterans, TO1. Clinical: Often involving the small and medium-sized artery and accompanying vein， segmental distribution， more common in males ，smokers ，2040 year old.66Thromboangiitis obliterans, TOB-mode images: Rough intimal, vascular wall uneven thickening, the inside diameter of t

23、he artery decreased, often below the popliteal artery.67Thromboangiitis obliterans, TOColor flow images ：Flow signals changed to be fine, defect or dot-like; if complete occlusion, no flow signal in the artery.68Thromboangiitis obliterans, TO4. Spectral Doppler: Variation Mild lesions: a triphasic f

24、low pattern with a clear spectral window; most cases: the wave form may be monophonic； complete occlusion: no wave form can be found.69male ,56Y thromboangiitis obliterans in the left anterior tibial artery70male ,56Y thromboangiitis obliterans in the left anterior tibial artery71male ,56Y thromboan

25、giitis obliterans in the left anterior tibial artery72Takayasus arteritis, TA1. Clinical: Often involving the aorta and its branches, chronic non-specific inflammation, more common in young women. Arterial wall stiffness, calcification and atrophy, adhesion with surrounding tissue, stenosis or occlu

26、sion2. B-mode image: More than two vessels affected；vascular wall uneven thickening, Uneven echo, stenosis or occlusion.73Color flow images: Not severe stenosis, blood flow in a single color; With the increasing degrees of the stenosis, flow signals changed to be fine; no flow signals can be found i

27、n occlusion.Spectral Doppler: Variation Diffuse lesions: the wave form may be monophonic，low speed flow spectrum; Local stenosis: high speed flow spectrum; Occlusion:no wave form can be found.74The wall of common carotid artery thickening, but intima is still smooth, the lumen is narrowing.75The wal

28、l of common carotid artery thickening, lumen is obviously smaller.76 Color flow images :The lumen is narrowing.7778Blood velocity increased.79Spectral Doppler of subclavian artery, the lumen is narrowing, blood velocity increased, near 4m/s.80Extremity venous thrombosis1. B-mode images:In the presen

29、ce of thrombus the vein will not compress. In the very early stages of thrombosis, the clot often has a degree of echogenicity. Within 1 or 2 days, the clot becomes more anechoic. it is often possible to seesubtle echoes. If the vein is totally occluded in the acute phase, it may appear distended.Ol

30、der thrombus, beyond two weeks in age, becomes more echogenic. 81A longitudinal B-mode image of a common femoral vein thrombosis82A transverse B-mode image of a peroneal vein thrombosis8384Extremity venous thrombosis2. Color flow images: There is an absence of color filling in occluded veins, even w

31、ith distal augmentation. This can be demonstrated in both longitudinal and transverse sections. 85A longitudinal color image of asuperficial femoral vein thrombosis86A transverse color image of a superficial femoral vein thrombosis87A color flow image of superficial femoral vein. Flow is seen between the thrombus and vein wall.88Extremity venous thrombosis3. Spectral Doppler: There is an absence of a spectral Doppler signal when the vein is completely occluded. When the vein contains a significant amount of partially occluding or free-floating thrombus, there is