arterial duplex scanning: pearls and pitfalls for the

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Outdated equipment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!