Clinical Application Note - Arterial Investigation of the Lower Limb 603350-2.pdf
ADVANCED POCKET DOPPLERS
CLINICAL APPLICATION NOTES
NOTE 1 Arterial Investigation of the Lower Limb
HOW TO USE THIS APPLICATION NOTE
PATIENT SYMPTOMS Verify that your patient’s symptoms
correspond to one or more of those listed in Figure 1.
LOCATING ARTERIES Figure 4 suggests probe position for
locating an artery.
DOPPLEX® EQUIPMENT REQUIRED Select the most
appropriate Dopplex® Pocket unit to perform the examination.
For suggestion of suitable Dopplex equipment, refer to Figure 2.
EXAMINATION RESULTS Taking careful note of your
Dopplex® display and arterial waveforms (if applicable), refer
to Figure 5 overleaf and compare your examination results
with those shown.
PROCEDURE If you have the Dopplex® Printa II Package or
Dopplex® Reporter Software Package (and a computer),
connect your Dopplex® bi-directional Doppler and
begin your examination, refer to Figure 3.
NOTES Refer to Figure 6 overleaf for general notes relating
to this form of examination for arterial disease.
WEAK OR ABSENT PULSES
DOPPLEX EQUIPMENT REQUIRED
Multi, Maxi or Rheo Dopplex® II unit, 5 or 8 MHz probe,
Dopplex® Printa II Package or Reporter Software
Lay patient supine and encourage relaxation.
Connect Printa II Package or a computer to your
Ensure ambient temperature is comfortable and
pulse rate is stable.
Commence examination at the common femoral.
Hold Dopplex® probe between forefinger and thumb
at a 45 degree angle and place over vessel.
Check Dopplex® display for directional flow and
Proceed with next examination site.
Diagnostic Products Division
NORMAL COMMON FEMORAL ARTERY
At the common femoral examination site in the lower limb, the Dopplex®
signal is typically tri-phasic. The initial systolic flow phase is followed by a
reverse flow phase where blood actually travels backwards up the leg. This is
usually followed by a third phase of forward flow before the next systole.
ABNORMAL COMMON FEMORAL ARTERY
Any proximal stenosis of the artery will produce a modification of the
normal velocity waveform. With a stenosis present the reverse flow
phase would be reduced and the third phase may disappear.
The reverse flow phase disappears as the degree of proximal
stenosis increases. With major stenosis or occlusion of the illiac
arteries, the flow is in one direction only. (refer to diagram D)
When a proximal occlusion and collateral circulation are present, the
waveform shows a slow rise time in systole with continuous flow
throughout the cardiac cycle. (see note in Fig. 6)
OCCLUSION OF ILIAC
EXAMPLE OF DISTAL
EXAMPLE OF NORMAL
POPLITEAL AND TIBIAL
DISTAL SUPERFICIAL FEMORAL OCCLUSION
If a distal superficial femoral obstruction is present at the same time as
B above, then a shoulder may appear on the downstroke of the systolic
phase.If turbulence is present, then forward and reverse flow may occur
at the same time.
NORMAL POPLITEAL AND TIBIAL ARTERIES
The waveform is similar to the common femoral artery but with
decreased amplitude. The shape of the arterial waveform is sensitive to
iliac, common femoral and superficial femoral arterial disease. As the
size of the stenosis increases, the popliteal and tibial arteries may also
lose the reverse flow phase. In cases of complete proximal occlusion
and collateral circulation blood flow is mono-phasic and continuous over
the cardiac cycle. (refer to diagrams B-D)
Although the loss of reverse flow phase in the cardiac cycle is normally an indication of the severity of arterial disease, some patients
will show no reverse flow due to recent exercise or high ambient temperature, producing vasodilated distal circulation.
This note is intended as a guide only. The above Dopplex® displays are an indication only. The number of arrows actually displayed
will vary according to the Dopplex® gain setting and probe position. If in doubt contact your local vascular studies unit. If you have any
questions regarding the products call Huntleigh Healthcare, Diagnostic Products Division.
References: Evans D.H., McDicken W.N. Skidmore R. and Woodcock J.P. Doppler Ultrasound:
Physics, Instrumentation and Clinical Applications. John Wiley, Chichester, 1989, pp. 233-242
Our thanks go to Professor John P. Woodcock, Dept of Medical Physics, University Hospital of Wales, Cardiff, UK
and Dr. Mo Aslam, Dept of Surgery. Hammersmith Hospital, London, UK
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NOTE 1 • Arterial Investigation Of The
NOTE 2 • Venous Investigation Of The
Lower Limb Using Doppler
NOTE 3 • Venous Investigation Of The
Lower Limb Using PPG
NOTE 4 • Screening For The Absence Of
An Acute DVT Using PPG
NOTE 5 • Using A Hand Held Doppler To
Assist With PICC Placement
Huntleigh Healthcare Limited
Diagnostic Products Division
35 Portmanmoor Road, Cardiff, CF24 5HN United Kingdom.
Tel: +44 (0)29 20485885 Fax: +44 (0)29 20492520
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Vascular Assist with Doppler,
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