下肢血管英文培訓(xùn)課件

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10/2/2022The anatomy of the peripheral The anatomy of the peripheral vascular2. The arterial anatomy of the lower limbCommon femoral arter

2、y, Superficial femoral artery,Profunda femoris artery,Popliteal artery, Anterior tibial artery, Posterior tibial artery, Tibioperoneal trunk,Peroneal artery, Dorsalis pedis artery.2下肢血管英文10/2/2022The anatomy of the peripheral The arterial anatomy of the lower limb3下肢血管英文10/2/2022The arterial anatomy

3、 of the loThe anatomy of the peripheral veins1. The upper limb venous system can be divided into 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10/2/2022The anatomy of the peripheral The anatomy of the

4、 peripheral veins The main superficial veins of the upper limb: Cephalic vein, Basilic vein, Median cubital vein.5下肢血管英文10/2/2022The anatomy of the peripheral The anatomy of the peripheral veins2. The main deep veins of the lower limb:Anterior tibial veins, Posterior tibial veins, Peroneal veins, Po

5、pliteal vein, Superficial femoral vein, Profunda femoris vein,Common femoral vein.6下肢血管英文10/2/2022The anatomy of the peripheral 7下肢血管英文10/2/20227下肢血管英文10/2/2022 The anatomy of the peripheral veins The main superficial veins in the lower limbs are the long saphenous vein (LSV) and short saphenous vei

6、n (SSV).8下肢血管英文10/2/2022 The anatomy of the peripheThe 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10/2/2022The anatomy of the peripheral Technical Aspects1. Patient preparation：Dont need preparation.2.

7、Patient position: in supine and erect position, prone.the limb is supinated and slightly abducted.10下肢血管英文10/2/2022Technical Aspects10下肢血管英文10/211下肢血管英文10/2/202211下肢血管英文10/2/202212下肢血管英文10/2/202212下肢血管英文10/2/202213下肢血管英文10/2/202213下肢血管英文10/2/2022Technical Aspects3. Equipment requirement A high-capac

8、ity 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.14下肢血管英文10/2/2022Technical AspectsDont abductNormal peripheral artery1.B-mode images: the lumen of a normal peripheral artery

9、 should appear clear, and the walls should be uniform along each arterial segment.15下肢血管英文10/2/2022Normal peripheral artery15下肢血管A longitudinal B-mode image of the superficial femoral artery, profunda femoris artery16下肢血管英文10/2/2022A longitudinal B-mode image of2. Color flow images：There should be c

10、olor filling to the vessel walls.17下肢血管英文10/2/20222. Color flow images：There shoA longitudinal color flow image of the common femoral artery18下肢血管英文10/2/2022A longitudinal color flow imagA transverse color flow image of the common femoral artery19下肢血管英文10/2/2022A transverse color flow image 3. Spect

11、ral 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10/2/20223. Spectral Doppler：20下肢血管英文1021下肢血管英文10/2/202221下肢血管英文10/2

12、/2022Normal peripheral vein1. B-mode images: The vein should appear clear and contain no echoes. The vein can be compressed.22下肢血管英文10/2/2022Normal peripheral vein22下肢血管英文23下肢血管英文10/2/202223下肢血管英文10/2/2022Normal peripheral vein2. Color flow images: Spontaneous phasic flow is usually seen in the larg

13、er veins. There should be complete color filling of the lumen in both longitudinal and transverse planes during a calf squeeze. 24下肢血管英文10/2/2022Normal peripheral vein24下肢血管英文25下肢血管英文10/2/202225下肢血管英文10/2/2022Anterior tibial veins26下肢血管英文10/2/2022Anterior tibial veins26下肢血管英文1Normal peripheral vein3

14、. 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 maneuver. 27下肢血管英文10/2/2022Normal peripheral vein27下肢血管英文spectral doppler of the superficial femoral vein28下肢

15、血管英文10/2/2022spectral doppler of the superfthe patient takes a deep inspiration or performs a Valsalva maneuver 29下肢血管英文10/2/2022the patient takes a deep inspispectral doppler of popliteal vein, at rest30下肢血管英文10/2/2022spectral doppler of popliteal 31下肢血管英文10/2/202231下肢血管英文10/2/202232下肢血管英文10/2/2022

16、32下肢血管英文10/2/2022AtherosclerosisThe earliest ultrasound sign is thickening of the intima and media (1.0mm) , in the bifurcation (1.2mm)33下肢血管英文10/2/2022Atherosclerosis33下肢血管英文10/2/20Atherosclerosis Atheroma：the intima and media (1.5mm) Multilevel disease and bilateral involvement are common.L-CFAR-C

17、FA34下肢血管英文10/2/2022AtherosclerosisL-CFAR-CFA34下肢血Atherosclerosis2. Color flow images：Flow signals change to be fine or defect.Arterial stenoses will be 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10

18、/2/2022Atherosclerosis35下肢血管英文10/2/20Atherosclerosis3. 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 velocity across the lesion associated with spectral broadening and turbulence jus

19、t distal to the lesion.36下肢血管英文10/2/2022Atherosclerosis36下肢血管英文10/2/2037下肢血管英文10/2/202237下肢血管英文10/2/202238下肢血管英文10/2/202238下肢血管英文10/2/202239下肢血管英文10/2/202239下肢血管英文10/2/202240下肢血管英文10/2/202240下肢血管英文10/2/202241下肢血管英文10/2/202241下肢血管英文10/2/202242下肢血管英文10/2/202242下肢血管英文10/2/202243下肢血管英文10/2/202243下肢血管英文1

20、0/2/202244下肢血管英文10/2/202244下肢血管英文10/2/2022True 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 .45下肢血管英文10/2/2022True aneurysm45下肢血管英文10/2/202246下肢血管英文10/2/202246下肢血管英文10/2/202

21、2True 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.47下肢血管英文10/2/2022True aneurysm47下肢血管英文10/2/202248下肢血管英文10/2/202248下肢血管英文10/2/2022True ane

22、urysm2. Color flow images & Spectral Doppler： true aneurysm will be seen color flow disorder.49下肢血管英文10/2/2022True aneurysm49下肢血管英文10/2/2022 False aneurysms False aneurysms, also known as pseudo-aneurysms, primarily occur following arterial puncture for catheter access, due to poor control of arteri

23、al bleeding following the procedure.50下肢血管英文10/2/2022 False aneurysms 50下肢血管英文10/2False 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. The false lumen often contains thrombus, F

24、alse aneurysms can increase in size over time.51下肢血管英文10/2/2022False aneurysms 51下肢血管英文10/2/2False 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 inside the fa

25、lse lumen, similar to the yin-yang sign.52下肢血管英文10/2/2022False aneurysms 52下肢血管英文10/2/2False 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 dias

26、tole.53下肢血管英文10/2/2022False aneurysms 53下肢血管英文10/2/254下肢血管英文10/2/202254下肢血管英文10/2/202255下肢血管英文10/2/202255下肢血管英文10/2/202256下肢血管英文10/2/202256下肢血管英文10/2/2022yin-yang sign57下肢血管英文10/2/2022yin-yang sign57下肢血管英文10/2/2058下肢血管英文10/2/202258下肢血管英文10/2/202259下肢血管英文10/2/202259下肢血管英文10/2/2022Dissecting aneurysms

27、Occur 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 wall. 60下肢血管英文10/2/2022Dissecting aneurysms60下肢血管英文10Dissecting aneurysms1. B-mode images: a false f

28、low 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10/2/2022Dissecting aneurysms61下肢血管英文1062下肢血管英文10/2/202262下肢血管英文10/2/2022Dissecting aneurysms2. Color flow images 63下肢血管英文10/2/2022Dissecting aneurysms63下肢血管英文10Ture a

29、neurysm 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 disturbanceyin-yang signcolor flow in

30、ture lumen and false lumen in different directionsAntidiastole64下肢血管英文10/2/2022Ture aneurysm False aneurysmsThromboangiitis obliterans, TO1. 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

31、文10/2/2022Thromboangiitis obliterans, TOThromboangiitis obliterans, TOB-mode images: Rough intimal, vascular wall uneven thickening, the inside diameter of the artery decreased, often below the popliteal artery.66下肢血管英文10/2/2022Thromboangiitis obliterans, TOThromboangiitis obliterans, TOColor flow i

32、mages ：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10/2/2022Thromboangiitis obliterans, TOThromboangiitis obliterans, TO4. Spectral Doppler: Variation Mild lesions: a triphasic flow pattern with a clear spectral window; most cases:

33、 the wave form may be monophonic； complete occlusion: no wave form can be found.68下肢血管英文10/2/2022Thromboangiitis obliterans, TOmale ,56Y thromboangiitis obliterans in the left anterior tibial artery69下肢血管英文10/2/2022male ,56Y thromboangiitis oblimale ,56Y thromboangiitis obliterans in the left anteri

34、or tibial artery70下肢血管英文10/2/2022male ,56Y thromboangiitis oblimale ,56Y thromboangiitis obliterans in the left anterior tibial artery71下肢血管英文10/2/2022male ,56Y thromboangiitis obliTakayasus arteritis, TA1. Clinical: Often involving the aorta and its branches, chronic non-specific inflammation, more

35、 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 wall uneven thickening, Uneven echo, stenosis or occlusion.72下肢血管英文10/2/2022Takayasus arteritis, TA72下肢血管Color f

36、low 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.Spectral Doppler: Variation Diffuse lesions: the wave form may be monophonic，low speed flow spectrum; Local stenosis:

37、 high speed flow spectrum; Occlusion:no wave form can be found.73下肢血管英文10/2/2022Color flow images: Not severe The wall of common carotid artery thickening, but intima is still smooth, the lumen is narrowing.74下肢血管英文10/2/2022The wall of common carotid arThe wall of common carotid artery thickening, l

38、umen is obviously smaller.75下肢血管英文10/2/2022The wall of common carotid art Color flow images :The lumen is narrowing.76下肢血管英文10/2/2022 Color flow images :The lumen 77下肢血管英文10/2/202277下肢血管英文10/2/2022Blood velocity increased.78下肢血管英文10/2/2022Blood velocity increased.78下肢血Spectral Doppler of subclavian

39、artery, the lumen is narrowing, blood velocity increased, near 4m/s.79下肢血管英文10/2/2022Spectral Doppler of subclavianExtremity venous thrombosis1. B-mode 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.

40、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.Older thrombus, beyond two weeks in age, becomes more echogenic. 80下肢血管英文10/2/2022Extremity venous thrombosis80下A longitudinal B-m

41、ode image of a common femoral vein thrombosis81下肢血管英文10/2/2022A longitudinal B-mode image ofA transverse B-mode image of a peroneal vein thrombosis82下肢血管英文10/2/2022A transverse B-mode image of a83下肢血管英文10/2/202283下肢血管英文10/2/2022Extremity venous thrombosis2. Color flow images: There is an absence of

42、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10/2/2022Extremity venous thrombosis84下A longitudinal color image of asuperficial femoral vein thrombosis85下肢血管英文10/2/2022A longitudinal color image of A tra

43、nsverse color image of a superficial femoral vein thrombosis86下肢血管英文10/2/2022A transverse color image of a A color flow image of superficial femoral vein. Flow is seen between the thrombus and vein wall.87下肢血管英文10/2/2022A color flow image of superficExtremity 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 normally a reduced flow pattern, which demonstrates little or no augmentation following distal compr