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TeA M YYe PG Digitally signed by TeAM YYePG DN: cn=TeAM YYePG, c=US, o=TeAM YYePG, ou=TeAM YYePG, email=yyepg@msn. com Reason: I attest to the accuracy and integrity of this document Date: 2005.09.30 09:08:43 +08'00' Peripheral Vascular Ultrasound To Wendy, Tony and June For Elsevier: Associate Development Editor: Dinah Thom Development Editor: Kerry McGechie Project Manager: Ailsa Laing Designer: Judith Wright Illustration Manager: Bruce Hogarth Peripheral Vascular Ultrasound HOW, WHY AND WHEN SECOND EDITION Abigail Thrush MSc Medical Physicist, Department of Clinical Physics, St Bartholomew’s Hospital, Bart’s and the London NHS Trust, London, UK Timothy Hartshorne Vascular Technologist, Department of Surgery, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2005 Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. ELSEVIER CHURCHILL LIVINGSTONE © 2005 Elsevier Limited. All rights reserved. The rights of Abigail Thrush and Timothy Hartshorne to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, USA: phone: (1) 215 238 7869, fax: (1) 215 238 2239, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. First published 1999 Second edition 2005 ISBN 0 443 07283 3 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress. Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the author assumes any liability for any injury and/or damage. The Publisher Printed in China v Contents Acknowledgments vi Preface vii 9. Duplex assessment of lower limb arterial disease 111 1. Introduction 1 10. Duplex assessment of upper extremity arterial disease 133 2. Ultrasound and imaging 5 11. Duplex assessment of aneurysms 145 3. Doppler ultrasound 23 12. Anatomy of the lower limb venous system and assessment of venous insufficiency 163 4. Creation of a color flow image 35 5. Blood flow and its appearance on color flow imaging 49 13. Duplex assessment of deep venous thrombosis and upper limb venous disorders 189 6. Factors that influence the Doppler spectrum 63 14. Graft surveillance and preoperative vein mapping for bypass surgery 207 7. Optimizing the scan 75 Appendix A: Decibel scale 225 Appendix B: Sensitivity and specificity 227 8. Ultrasound assessment of the extracranial cerebral circulation 85 Index 229 vi PERIPHERAL VASCULAR ULTRASOUND Acknowledgments We would like to thank David Evans, Hayley Handford, Pouran Khodabakhsh, Nick London, Salvatore Luca, May Naylor, Ross Naylor, Yvonne Sensier, and Jo Walker for their help and support in the preparation of this book. vii Preface Vascular ultrasound is a speciality in its own right and vascular surgeons are becoming increasingly dependent on the skills of vascular sonographers for the investigation of patients suffering from peripheral vascular disease. This book aims to provide an understanding of the principles and practice of vascular ultrasound. An introduction to some of the basic theory behind the science and technology of ultrasound is included. This will help sonographers to understand the function of scanner controls and enable them to obtain optimal images and Doppler recordings. B-mode imaging, color flow and spectral Doppler images are all prone to artefacts, and it is essential that their presence be recognized. The potential sources of errors in any measurements made by ultrasound should be understood. Specific disorders of the arterial and venous systems are covered, and the techniques for diagnosing these problems are described. Examples of normal and abnormal images and Doppler recordings are included and the interpretation of these discussed. British readers please note that the publishers have used American spelling in this edition. We hope this book will serve as a useful reference to sonographers new to this field. London, 2005 Leicester, 2005 Abigail Thrush Timothy Hartshorne This page intentionally left blank