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Ultrasound Vascular Technology > Duplex/Color Flow imaging (UE) > Flashcards

Duplex/Color Flow imaging (UE) Flashcards

1
Q

Capabilities of duplex/color flow imaging?

A
  • localize stenosis / occlusion; evaluate degree of stenosis
  • determine the presence/absence of aneurysm
  • post-op study: hemodialysis access or arterial bypass graft
  • detect AVF’s or other unusual abnormality
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2
Q

Limitations of duplex/color flow imaging?

A
  • limited access to extremity
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3
Q

Limitations pertaining to hemodialysis access grafts:

A
  • graft angulation
  • difficult to adequately evaluate the outflow vein in an obese patient
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4
Q

Patient positioning for duplex/color flow imaging:

A
  • supine with small pillow under head
  • extremity close to the examiner
  • arm is at a 45 degree angle from the body and externally rotated
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5
Q

What is a “pledged positition”

A

arm is at a 45 degree angle from the body and externally rotated

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6
Q

Duplex scanning physical principles:

A
  • combination of real-time B-mode imaging and doppler spectral analysis
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7
Q

Doppler color flow imaging physical principles:

A
  • doppler information is displayed on image after evaluated for phase (direction toward or away from transducer) and its frequency content (hue or shade of color)
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8
Q

What is the sample size for acquiring pulsed Doppler information?

A

1-1.5 mm

  • size can be increased if needed
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9
Q

What transducer is used for duplex/color flow imaging?

A

7 or 5 MHz linear array transducer

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10
Q

Color/duplex scanning is also used to evaluate what arteries?

A
  • Subclavian
  • Axillary
  • Brachial
  • Radial
  • Ulnar
  • Palmar arch (if needed)
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11
Q

What is the main use for evaluation of duplex/color flow imaging in the upper extremity?

A

evaluate dialysis access grafts

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12
Q

Is it common for upper extremity arteries to become stenotic?

A

no

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13
Q

A patent dialysis access, as well as a stenotic one can produce what?

A

a “thrill”

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14
Q

How do you evaluate dialysis access grafts?

A
  • Inflow artery
  • Arterial anastomosis
  • Continue through the body of the graft
  • Observe for aneurysm, puncture sites, peri-graft fluid
  • If color is available, observe flow changes, turbulence, flow channel changes
  • Venous anastomosis
  • Outflow veing
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15
Q

Dialysis access assessment sites include:

A

inflow artery, anastomosis, outflow artery

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16
Q

What is a Brescia-Cimino fistula used for?

A

Dialysis access

17
Q

Dialysis access examples include:

A

Brescia-Cimino fistula, straight, looped, synthetic grafts

18
Q

Interpretation of stenosis:

A
  • currently, no criteria for classifying disease as there is for LE
  • Normal peak systolic velocities vary widely with skin temperature changes. Doppler signal quality is usually triphasic
  • If a >50% diameter reduction is present, observe for characteristics of the “stenosis profile”
19
Q

Interpretation of occlusion:

A
  • Observe the lack of Doppler signals and the proverbial “thump” which is obtained proximal to occlusion
20
Q

Interpretation of aneurysm:

A
  • Dilation of the vessel from degeneration and/or weakening of the wall
21
Q

Where can an aneurysm form in response to using the palm as a hammer?

A

Ulnar

22
Q

What aneurysm is associated with embolization to the digits?

A

Subclavian

23
Q

What is a normal PSV and DSV with hemodialysis access?

A

elevated

24
Q

What could low PSV in access graft indicate?

A

arterial inflow problems

25
Q

Where is the most common site for stenosis with hemodialysis access?

A

Venous anastomosis and outflow vein

26
Q

How do you assess a possible “steal”?

A

-With dialysis access open/functioning use PPG to evaluate flow in at least 2 digits, one at a time
- Apply manual pressure to dialysis access and retake digit PPG tracings and/or pressures

27
Q

What happens if flow improves with pressure to dialysis access?

A

there is a steal

28
Q

What happens if flow stays the same without pressure to dialysis access?

A

there is probably not a steal

29
Q

What results in large blood volumes shunted from artery to lower resistant venous circulations and will increase venous return?

A

congestive heart failure

Ultrasound Vascular Technology (12 decks)

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