Ultrasound Diagnosis of Acute Arterial Thrombosis · Approaching acute occlusion, increase in...
Transcript of Ultrasound Diagnosis of Acute Arterial Thrombosis · Approaching acute occlusion, increase in...
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Ultrasound Diagnosis of Acute Arterial Thrombosis
Joseph P. Hughes, RVT, RVS, FSVU
President, Society for Vascular Ultrasound
Director of Business Development, NAVIX Diagnostix
Friday, April 27, 2018
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Disclosures
• None relevant
• Special thanks to Patrick Washko, BS, RVT, FSVU for some images
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Overview
• Clinical Presentation
• Physiologic Presentation
• Duplex Presentation
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Clinical Presentation
• Sudden onset of the “6 P’s”:
• Pain
• Pallor
• Pulselessness
• Parathesia
• Paralysis
• Polar
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Finding the Occlusion
• Emboli = SUDDEN OCCLUSION• No collaterals
• PALPATION can help isolate the occlusion• Pulses, polar, paralysis
• Usually cardiac but could be from aneurysm, ruptured plaque or dissection• During duplex, go as high as
possible
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Physiologic Findings
• Generally absent distal waveforms BUT what flow there is may be blunted with no diastolic flow• If chronic, generally there will be
continuous diastolic flow distal
• Different than a rounded monophasic signal
• Pressure readings not always appreciated
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Approaching acute occlusion, increase in resistance is noted
Courtesy: Patrick Washko
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Case Study
• 50 y.o. male woke up with sudden pain and inability to move left lower extremity
• Cold on palpation with no pulses from groin to foot
• Duplex ordered
• High resistance external iliac artery
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Duplex Findings – B-mode appearance
• Low-level, mostly homogeneous echoes
• May be mistaken for artifact
• Must confirm with Doppler
• Can also confirm with cineloops
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Doppler the area of suspected occlusion
• Those “blips” are probably not
flow
• Movement of the embolus as
the pulse hits above
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Differentiate the artery from vein
• Optional
• And it sounds silly but provide as much information as possible
• Have seen mistakes…
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Cineloops
• Movement of the thromboembolism or flap
• Differentiate artifact
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Multiple approaches
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Color Doppler
• The absence of color does not
mean that there is not flow
• Decrease PRF
• Power Doppler
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Summary
• Clinical presentation is the key• Symptoms are sudden
• Palpate for the level of the occlusion (saves time)
• Investigate as far proximal as you can once you’ve found the suspected lesion
• Don’t wait for me to come in to do a STAT study in the middle of the night – call a surgeon/interventionalist first so they’re ready to fix the problem• Of course, if I’m there you should still find a surgeon/interventionalist
• TIME = LEG