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Doppler ultrasonography of the arteries of the lower extremities
Last reviewed: 23.04.2024
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Diagnosis of peripheral arterial diseases of the extremities is based on a clinical examination involving Ratcshow or Allen samples, pulse estimation, walking time and measurement of the ankle-brachial index (LIP). Based on the results of these studies, indications for a color duplex sonography of the arteries of the limb are determined.
Traditionally, in the diagnosis of occlusive disease of peripheral arteries, digital subtraction angiography was considered the gold standard. However, color duplex sonography of peripheral arteries is becoming an increasingly important non-invasive diagnostic technique.
The main indications for color duplex sonography, in addition to assessing the occlusive disease of peripheral arteries and widespread atherosclerosis, are a quantitative assessment of the degree of stenosis in peripheral arterial occlusive disease, functional examination and control after reconstructive surgery (overlap anastomosis, endarterioectomy, fistula for hemodialysis). Color duplex sonography can reduce the frequency of diagnostic digital subtraction angiography before the implementation of interventional and surgical procedures on the vessels. Among the therapeutic applications of color duplex sonography is compression therapy pseudoaneurysm, which allows to reduce the number of vascular surgical interventions.
The procedure for the examination of the arteries of the lower limb
Research always begins with visualization of the pelvic arteries. Several zones have been identified, the examination of which makes it possible to differentiate physiological and pathological changes. Therefore, there is no need to examine the entire lower limb.
The procedure for examining the arteries of the upper and lower limbs
The picture of normal blood flow at rest
After identifying the vessels in the B-mode, examine them in the mode of color duplex sonography about the longitudinal axis and, if necessary, along the transverse. The color regime is initially used only in the region of the shin and forearm, because it allows to determine the localization and the course of the vessels. Choose pulse repetition frequency before measuring blood flow velocity.
Normal blood flow in the arteries of the lower limb
Color duplex sonography in the diagnosis of diseases of peripheral arteries
Occlusion disease of peripheral arteries (OBPA)
Occlusion disease of peripheral arteries, caused by atherosclerosis, is the most common arterial disease of the extremities (95%). Colored duplex sonography can be used for screening patients with clinical suspicion on OPSA and for monitoring after surgical treatment. About 10% of the population have disorders of peripheral circulation, 10% of them have arteries of the upper extremity, and 90% have lower extremities (35% - pelvis, 55% shin). Often there are lesions at several levels and a bilateral disease. The earliest ultrasound sign of clinically latent atherosclerosis is the thickening of the intima and media.
Ultrasound signs of diseases of peripheral arteries
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