1、The anatomy of the peripheral vascular1.The arterial anatomy of the upper limbSubclavian artery,Axillary artery,Brachial arteryRadial artery,Ulnar artery.1下肢血管英文2022-10-21The anatomy of the peripheral vascular2.The arterial anatomy of the lower limbCommon femoral artery,Superficial femoral artery,Pr
2、ofunda femoris artery,Popliteal artery,Anterior tibial artery,Posterior tibial artery,Tibioperoneal trunk,Peroneal artery,Dorsalis pedis artery.2下肢血管英文2022-10-21The arterial anatomy of the lower limb3下肢血管英文2022-10-21The anatomy of the peripheral veins1.The upper limb venous system can be divided int
3、o the deep and superficial veins.The main deep veins of the upper limb:Radial vein,Ulnar vein,Brachial vein,Axillary vein,Subclavian vein.4下肢血管英文2022-10-21The anatomy of the peripheral veins The main superficial veins of the upper limb:Cephalic vein,Basilic vein,Median cubital vein.5下肢血管英文2022-10-21
4、The anatomy of the peripheral veins2.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.6下肢血管英文2022-10-217下肢血管英文2022-10-21 The anatomy of the peripheral veins The main sup
5、erficial veins in the lower limbs are the long saphenous vein(LSV)and short saphenous vein(SSV).8下肢血管英文2022-10-21The anatomy of the peripheral veins 3.Veins contain valves to prevent the reflux of blood to the extremities.Venous valves are bicuspid.9下肢血管英文2022-10-21Technical Aspects1.Patient prepara
6、tion：Dont need preparation.2.Patient position:in supine and erect position,prone.the limb is supinated and slightly abducted.10下肢血管英文2022-10-2111下肢血管英文2022-10-2112下肢血管英文2022-10-2113下肢血管英文2022-10-21Technical Aspects3.Equipment requirement A high-capacity scan converter the upper limb:510MHz the lower
7、 limb:57MHz 4.Methods：longitudinal scan plane and transverse plane.Dont abducted strongly,as the veins can be compressed.14下肢血管英文2022-10-211.B-mode images:the lumen of a normal peripheral artery should appear clear,and the walls should be uniform along each arterial segment.15下肢血管英文2022-10-21A longi
8、tudinal B-mode image of the superficial femoral artery,profunda femoris artery16下肢血管英文2022-10-212.Color flow images：There should be color filling to the vessel walls.17下肢血管英文2022-10-21A longitudinal color flow image of the common femoral artery18下肢血管英文2022-10-21A transverse color flow image of the c
9、ommon femoral artery19下肢血管英文2022-10-213.Spectral Doppler：The normal spectral doppler display demonstrates a triphasic flow pattern with a clear spectral window.In elderly patients or patients with poor cardiac output,the wave form may be biphasic or even monophonic.20下肢血管英文2022-10-2121下肢血管英文2022-10-
10、211.B-mode images:The vein should appear clear and contain no echoes.The vein can be compressed.22下肢血管英文2022-10-2123下肢血管英文2022-10-212.Color flow images:Spontaneous phasic flow is usually seen in the larger veins.There should be complete color filling of the lumen in both longitudinal and transverse
11、planes during a calf squeeze.24下肢血管英文2022-10-2125下肢血管英文2022-10-21Anterior tibial veins26下肢血管英文2022-10-213.Spectral Doppler:The Doppler signal at the level of the common femoral vein should exhibit a spontaneous phasic flow pattern,which temporarily ceases when the patient performs a Valsalva maneuve
12、r.27下肢血管英文2022-10-21spectral doppler of the superficial femoral vein28下肢血管英文2022-10-21the patient takes a deep inspiration or performs a Valsalva maneuver 29下肢血管英文2022-10-21spectral doppler of popliteal vein,at rest30下肢血管英文2022-10-2131下肢血管英文2022-10-2132下肢血管英文2022-10-211.The earliest ultrasound sign
13、is thickening of the intima and media(1.0mm),in the bifurcation (1.2mm)33下肢血管英文2022-10-211.Atheroma：the intima and media(1.5mm)2.Multilevel disease and bilateral involvement are common.L-CFAR-CFA34下肢血管英文2022-10-212.Color flow images：Flow signals change to be fine or defect.Arterial stenoses will be
14、demonstrated as areas of color flow disturbance or aliasing.An occlusion is demonstrated by a total absence of color flow in the vessel.35下肢血管英文2022-10-213.Spectral Doppler：If the artery is no significant stenosis,spectral doppler is normal.In the presence of a significant stenosis,there will be an
15、increase in flow velocity across the lesion associated with spectral broadening and turbulence just distal to the lesion.36下肢血管英文2022-10-2137下肢血管英文2022-10-2138下肢血管英文2022-10-2139下肢血管英文2022-10-2140下肢血管英文2022-10-2141下肢血管英文2022-10-2142下肢血管英文2022-10-2143下肢血管英文2022-10-2144下肢血管英文2022-10-211.B-mode images：T
16、he artery appears abnormally enlarged,the lesion diameter is 1.5 times more than the adjacent normal diameter,wall of the aneurysm is artery wall.45下肢血管英文2022-10-2146下肢血管英文2022-10-211.B-mode images：The shape of the aneurysm can vary,you could found hypoechoic thrombosis in the aneurysm.B-mode imagin
17、g is used to assess the size,length and amount of thrombus within the aneurysm.47下肢血管英文2022-10-2148下肢血管英文2022-10-212.Color flow images&Spectral Doppler：true aneurysm will be seen color flow disorder.49下肢血管英文2022-10-21 False aneurysms False aneurysms,also known as pseudo-aneurysms,primarily occur fol
18、lowing arterial puncture for catheter access,due to poor control of arterial bleeding following the procedure.50下肢血管英文2022-10-21False aneurysms 1.Blood flow backward and forward through a hole in the arterial wall into the surrounding tissue,forming a flow cavity in the tissue adjacent to the artery
19、.The false lumen often contains thrombus,False aneurysms can increase in size over time.51下肢血管英文2022-10-21False aneurysms 2.Color flow images：The color flow image typically demonstrates a high-velocity jet originating from the defect in the artery wall,which is associated with a swirling pattern ins
20、ide the false lumen,similar to the yin-yang sign.52下肢血管英文2022-10-21False aneurysms 3.Spectral Doppler：Spectral Doppler usually demonstrates an equal forward flow and reverse flow component to the arterial jet as flow enters the false aneurysm during systole and exits during diastole.53下肢血管英文2022-10-
21、2154下肢血管英文2022-10-2155下肢血管英文2022-10-2156下肢血管英文2022-10-21yin-yang sign57下肢血管英文2022-10-2158下肢血管英文2022-10-2159下肢血管英文2022-10-21Dissecting 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
22、sometimes of the media,from the artery wall.60下肢血管英文2022-10-21Dissecting 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.61下肢血管英文2022-10-2162下肢血管英文2022-10-21Dissecting aneurysms2.Color flow
23、 images 63下肢血管英文2022-10-21Ture aneurysm False aneurysms Dissecting aneurysmscauseatherosclerosisinjury,infectionatherosclerosis,marfan syndromeB-mode imagesthe artery enlargearteria cystic massa ture lumen and a false lumenwall of the aneurysmarterial wallsurrounding tissuecolor flow images disturba
24、nceyin-yang signcolor flow in ture lumen and false lumen in different directionsAntidiastole64下肢血管英文2022-10-211.Clinical:Often involving the small and medium-sized artery and accompanying vein，segmental distribution，more common in males，smokers，2040 year old.65下肢血管英文2022-10-212.B-mode images:Rough i
25、ntimal,vascular wall uneven thickening,the inside diameter of the artery decreased,often below the popliteal artery.66下肢血管英文2022-10-213.Color flow images：Flow signals changed to be fine,defect or dot-like;if complete occlusion,no flow signal in the artery.67下肢血管英文2022-10-214.Spectral Doppler:Variati
26、on Mild lesions:a triphasic flow pattern with a clear spectral window;most cases:the wave form may be monophonic；complete occlusion:no wave form can be found.68下肢血管英文2022-10-21male,56Y anterior tibial artery69下肢血管英文2022-10-21male,56Y anterior tibial artery70下肢血管英文2022-10-21male,56Y anterior tibial a
27、rtery71下肢血管英文2022-10-211.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 occlusion2.B-mode image:More than two vessels affected；vascular wal
28、l uneven thickening,Uneven echo,stenosis or occlusion.72下肢血管英文2022-10-213.Color 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 in occlusion.4.Spectral Doppler:Variation Diffuse lesi
29、ons:the wave form may be monophonic，low speed flow spectrum;Local stenosis:high speed flow spectrum;Occlusion:no wave form can be found.73下肢血管英文2022-10-21The wall of common carotid artery thickening,but intima is still smooth,the lumen is narrowing.74下肢血管英文2022-10-21The wall of common carotid artery
30、 thickening,lumen is obviously smaller.75下肢血管英文2022-10-21 Color flow images:The lumen is narrowing.76下肢血管英文2022-10-2177下肢血管英文2022-10-21Blood velocity increased.78下肢血管英文2022-10-21Spectral Doppler of subclavian artery,the lumen is narrowing,blood velocity increased,near 4m/s.79下肢血管英文2022-10-211.B-mode
31、 images:In the presence 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 appea
32、r distended.Older thrombus,beyond two weeks in age,becomes more echogenic.80下肢血管英文2022-10-21A longitudinal B-mode image of a common femoral vein thrombosis81下肢血管英文2022-10-21A transverse B-mode image of a peroneal vein thrombosis82下肢血管英文2022-10-2183下肢血管英文2022-10-212.Color flow images:There is an abse
33、nce of color filling in occluded veins,even with distal augmentation.This can be demonstrated in both longitudinal and transverse sections.84下肢血管英文2022-10-21A longitudinal color image of asuperficial femoral vein thrombosis85下肢血管英文2022-10-21A transverse color image of a superficial femoral vein thro
34、mbosis86下肢血管英文2022-10-21A color flow image of superficial femoral vein.Flow is seen between the thrombus and vein wall.87下肢血管英文2022-10-213.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 o
35、ccluding or free-floating thrombus,there is normally a reduced flow pattern,which demonstrates little or no augmentation following distal compression.88下肢血管英文2022-10-2189下肢血管英文2022-10-21During Valsalva testing,if there has reflux across the vein,more than 1s,we call this disease 90下肢血管英文2022-10-21Va
36、lsalva test:The patient is told to inhale deeply and then to push out and expand the cheeks without breathing out,while at the same time bearing pressure down on the abdomen.This produces an increase in intra-abdominal pressure,thus increasing the venous blood pressure in the iliac and femoral veins
37、.91下肢血管英文2022-10-21During Valsalva testing,it is usual to see the common femoral vein distending,there should be no reflux across the proximal superficial femoral vein.92下肢血管英文2022-10-2193下肢血管英文2022-10-2194下肢血管英文2022-10-2195下肢血管英文2022-10-21 evere venous reflux of 2s duration is demonstrated across the venous valvular.Spectral Doppler is used to grade the duration of venous reflux.96下肢血管英文2022-10-2197下肢血管英文2022-10-21Which disease did this patient suffer from?98下肢血管英文2022-10-2199下肢血管英文2022-10-21
