下肢血管-英文-课件

下肢血管-英文 PPTThe anatomy of the peripheral vascular1.The arterial anatomy of the upper limbSubclavian artery,Axillary artery,Brachial arteryRadial artery,Ulnar artery.2大家好The anatomy of the peripheral vascular2.The arterial anatomy of the lower limbCommon femoral artery,Superficial femoral artery,Profunda femoris artery,Popliteal artery,Anterior tibial artery,Posterior tibial artery,Tibioperoneal trunk,Peroneal artery,Dorsalis pedis artery.3大家好The arterial anatomy of the lower limb4大家好The 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.5大家好The anatomy of the peripheral veins The main superficial veins of the upper limb:Cephalic vein,Basilic vein,Median cubital vein.6大家好大家学习辛苦了，还是要坚持继续保持安静继续保持安静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.8大家好9大家好 The anatomy of the peripheral veins The main superficial veins in the lower limbs are the long saphenous vein(LSV)and short saphenous vein(SSV).10大家好The anatomy of the peripheral veins 3.Veins contain valves to prevent the reflux of blood to the extremities.Venous valves are bicuspid.11大家好Technical Aspects1.Patient preparation：Dont need preparation.2.Patient position:in supine and erect position,prone.the limb is supinated and slightly abducted.12大家好13大家好14大家好15大家好Technical 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.16大家好Normal peripheral artery1.B-mode images:the lumen of a normal peripheral artery should appear clear,and the walls should be uniform along each arterial segment.17大家好A longitudinal B-mode image of the superficial femoral artery,profunda femoris artery18大家好2.Color flow images：There should be color filling to the vessel walls.19大家好A longitudinal color flow image of the common femoral artery20大家好A transverse color flow image of the common femoral artery21大家好3.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.22大家好23大家好Normal peripheral vein1.B-mode images:The vein should appear clear and contain no echoes.The vein can be compressed.24大家好25大家好Normal peripheral vein2.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 planes during a calf squeeze.26大家好27大家好Anterior tibial veins28大家好Normal peripheral vein3.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.29大家好spectral doppler of the superficial femoral vein30大家好the patient takes a deep inspiration or performs a Valsalva maneuver 31大家好spectral doppler of popliteal vein,at rest32大家好33大家好34大家好Atherosclerosis1.The earliest ultrasound sign is thickening of the intima and media(1.0mm),in the bifurcation (1.2mm)35大家好Atherosclerosis Atheroma：the intima and media(1.5mm)Multilevel disease and bilateral involvement are common.L-CFAR-CFA36大家好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.37大家好Atherosclerosis3.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 just distal to the lesion.38大家好39大家好40大家好41大家好42大家好43大家好44大家好45大家好46大家好True 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.47大家好48大家好True 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.49大家好50大家好True aneurysm2.Color flow images&Spectral Doppler：true aneurysm will be seen color flow disorder.51大家好 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.52大家好False 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,False aneurysms can increase in size over time.53大家好False 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 false lumen,similar to the yin-yang sign.54大家好False 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.55大家好56大家好57大家好58大家好yin-yang sign59大家好60大家好61大家好Dissecting 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 wall.62大家好Dissecting 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.63大家好64大家好Dissecting aneurysms2.Color flow images 65大家好Antidiastole66大家好Thromboangiitis obliterans,TO1.Clinical:Often involving the small and medium-sized artery and accompanying vein，segmental distribution，more common in males，smokers，2040 year old.67大家好Thromboangiitis obliterans,TO2.B-mode images:Rough intimal,vascular wall uneven thickening,the inside diameter of the artery decreased,often below the popliteal artery.68大家好Thromboangiitis obliterans,TO3.Color flow images：Flow signals changed to be fine,defect or dot-like;if complete occlusion,no flow signal in the artery.69大家好Thromboangiitis obliterans,TO4.Spectral Doppler:Variation 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.70大家好male,56Y thromboangiitis obliterans in the left thromboangiitis obliterans in the left anterior tibial artery71大家好male,56Y thromboangiitis obliterans in the left thromboangiitis obliterans in the left anterior tibial artery72大家好male,56Y thromboangiitis obliterans in the left thromboangiitis obliterans in the left anterior tibial artery73大家好Takayasus 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 occlusion2.B-mode image:More than two vessels affected；vascular wall uneven thickening,Uneven echo,stenosis or occlusion.74大家好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.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.75大家好The wall of common carotid artery thickening,but intima is still smooth,the lumen is narrowing.76大家好The wall of common carotid artery thickening,lumen is obviously smaller.77大家好 Color flow images:The lumen is narrowing.78大家好79大家好Blood velocity increased.80大家好Spectral Doppler of subclavian artery,the lumen is narrowing,blood velocity increased,near 4m/s.81大家好Extremity 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.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.82大家好A longitudinal B-mode image of a common femoral vein thrombosis83大家好A transverse B-mode image of a peroneal vein thrombosis84大家好85大家好Extremity venous thrombosis2.Color flow images:There is an absence of color filling in occluded veins,even with distal augmentation.This can be demonstrated in both longitudinal and transverse sections.86大家好A longitudinal color image of asuperficial femoral vein thrombosis87大家好A transverse color image of a superficial femoral vein thrombosis88大家好A color flow image of superficial femoral vein.Flow is seen between the thrombus and vein wall.89大家好Extremity 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 compression.90大家好91大家好Venous valvular incompetenceDuring Valsalva testing,if there has reflux across the vein,more than 1s,we call this disease Venous valvular incompetence.92大家好Venous valvular incompetenceValsalva 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.93大家好Venous valvular incompetenceDuring Valsalva testing,it is usual to see the common femoral vein distending,there should be no reflux across the proximal superficial femoral vein.94大家好Normal95大家好Venous valvular incompetenceVenous valvular incompetence96大家好Venous valvular incompetenceVenous valvular incompetence97大家好 evere venous reflux of 2s duration is demonstrated across the venous valvular.Spectral Doppler is used to grade the duration of venous reflux.98大家好99大家好Which disease did this patient suffer from?100大家好101大家好