Arterial Duplex

contrast arteriography

duplex arteriography

imaging technique using ionizing radiation and contrast material to show detailed arterial system configuration (gold standard)

ultrasound imaging of arterial system to identify atherosclerotic disease and pathology and find detailed map of system

plaque

aneurysm

deposit of fatty material within vessel walls (characteristic of atherosclerosis)

localized dilation of artery involving all 3 wall layers

peripheral arterial occlusive disease (PAOD)

progressive disease in which the arteries become narrowed

usually caused by plaque leading to athero

risk factors for PAOD

smoking

diabetes

high cholesterol

high blood pressure

also: age, gender (male)

major symptom of PAOD

intermittent claudication

intermittent claudication

pain provoked by activity & relieved by rest

area of pain occurs distal to site of blockage

chronic claudication: rest pain, ulcers, hair loss, nail thickening

6 P’s of PAOD

pain

pallor

pulselessness

paresthesia

paralysis

poikilothermia

indications for LEA exam

palpable mass

known abdominal aneurysm

trauma

iatrogenic cause

abnormal gray scale evaluation

atherosclerotic plaque can be seen: homogenous or heterogenous, smooth or irregular

calcifications can be present creating shadowing

urgent findings: aneurysms & dissections

thrombus or blood clot

can form due to narrowing lumen (differentiate from plaque)

arterial dissection

detached intima layer

arterial aneursysm

can be bilateral or multilevel

aneurysm present if diameter of vessel is 1.5 times greater than adjacent

document presence of thrombus in aneurysm too

misdidentifications

lymph nodes and nerves can be mistaken for arteries

pseduoaneurysm

abnormal outpouching of artery

usually result of injury

not encased by all 3 layers in arterial wall

different from true aneurysm which is when wall stretches and forms a bulge

stenosis characteristics

elevated PSV w/in stenosis

velocity ratios used to classify disease severity

velocity in stenosis / velocity prox to stenosis

ratio >2 = >50% stenosis

ratio >3 = >70% stenosis

post-stenosis

postenotic turbulence

dampened distal waveform