arterial duplex scanning: pearls and pitfalls for the
TRANSCRIPT
ARTERIAL DUPLEX SCANNING:
PEARLS AND PITFALLS FOR THE TECHNOLOGIST
Stephanie Wilson, BS, RDMS, RVT, FSVUSVU Vice President
Coordinator, Vascular Sonography
South Hills School of Business & Technology
Milton S. Hershey Medical Center Vascular Lab
NO DISCLOSURES
3/6/2019
ARTERIAL DUPLEX
PEARLS PITFALLS
Non invasive
No contrast
Less expensive
Provides physiologic info
Vessel wall assessment
Inexperience
Time commitment
Outdated equipment
Inadequate history
Vessel calcification
Kupinski, A. M. (2013). The Vascular System. Baltimore, MD: Lippincott Williams & Wilkins.
WHAT IS THE INDICATION?
What is the clinical question?
Provide as much detail as possible
Examine the chart PRIOR to the exam
New patient?
Past procedures?
Prior duplex exams?
Prior ABIs?
TIME COMMITMENT
Call the ordering physician/provider
Explain the types of exams consider ABI vs duplex
Daigle, R. (2014). Techniques in Noninvasive Vascular Diagnosis 4th Ed. Littleton, CO:
Summer Publishing.
TAKE A GOOD HISTORY!
Talk to your patient about SYMPTOMS
Claudication/rest pain
Examine the legs for SIGNS of disease
Shiny skin, thickened toenails, hair loss, ulcers
Image courtesy: nursingquality.org
Venous Ulcers Arterial Ulcers
Location Near medial
malleolus
Tibial area, toes, bony
prominences
Appearance Shallow, irregular
shape
Deep, regular shape
Bleeding Venous ooze Little bleeding
Other findings Stasis dermatitis:
brawny discoloration,
varicosities
Trophic changes: shiny
skin, loss of hair,
thickened toenails
ABIs
SURVEY to determine MAJOR
FINDINGS B-mode -
plaque/aneurysms/calcification
BPG? Stents?
Color Doppler
Vessel patency
Severe aliasing for stenosis
Occlusion?
http://www.intersocietal.org/vascular/main/vascular_standards.htm
STANDARDSIAC AND SVU
B-mode LONG axis
CFA, DFA, SFA, Pop A
SD - CFA, DFA SFA, Pop A, tibials
SD - EVERY stenosis
Pre – AT – Post
40cm/s
350cm/s
150cm/s
Pre AT Post
PROBLEM ZONES
Inguinal region
Distal thigh
Proximal Calf
Why
Depth of vessels
Increased amount of disease
SOLUTIONS - USE YOUR TECHNOLOGY!
Linear TDR Curved TDR
Excellent resolution Widened field of view
Limited field of view Increase penetration
Limited penetration
CALCIFICATION
Use multiple insonation planes
Increase color/power Doppler gain
Increase sensitivity and persistence
Use compound imaging
Sweep spectral SV through area – spectral is more powerful and
has a better chance of penetration through calcification
Image courtesy: scielo.org
WAVEFORM NOMENCLATUREWaveform terminology is being evaluated
for standardization by a collaborative effort
between SVU and SVM.
Expected publication in 2019
PRELIMINARY INTERPRETATION
Make it meaningful!
- Include specific history esp. procedures to save time on future scans
- Follow lab diagnostic criteria
- Identify CLINCALLY SIGNIFICANT changes compared to prior exams
% category stenosis
0.15 change in ABI
- Identify technical limitations
- Include incidental findings
THANK YOU!