Diagnostic ultrasound ( PDFDrive )

980 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
A
B
FIG. 27.21 Thoracic Outlet Syndrome. (A) Normal baseline subclavian artery waveform. (B) Altered waveform during hyperextension, with
compression against the clavicle causing stenosis.
A
B
FIG. 27.22 Radial Artery Evaluation for Coronary Bypass Graft. (A) Patent palmar arch, with reversal of low in the supericial palmar arch
on radial artery compression at the wrist. (B) Incomplete palmar arch, with lack of low in the supericial palmar arch on radial artery compression
at the wrist.
in very large patients or those with substantial extremity edema.
Gray-scale imaging should include compression and should be
performed in the transverse plane.
Color low and spectral analysis are the most common applications
of Doppler sonography, with occasional use of power
Doppler. Both techniques evaluate the disease process in the
peripheral veins and give additional information regarding altered
venous hemodynamics. Anatomic and functional detail makes
sonography a valuable tool. Color Doppler sonography can be
used to evaluate venous segments that cannot be directly assessed
by compression, such as the subclavian veins. Power Doppler
provides improved detection of very slow low, especially in small
veins. All spectral Doppler waveforms should be obtained in the
longitudinal plane.
Lower Extremity Veins
Normal Anatomy
Deep Venous System. he venous anatomy of the leg is
illustrated in Fig. 27.24. he common femoral vein (CFV) begins
at the level of the inguinal ligament as the continuation of the
external iliac vein and extends caudally to the bifurcation into
the femoral vein (FV) and the profunda femoris vein, which lie
medial to the adjacent artery. he FV courses medially to the
adjacent artery through the adductor canal in the caudal thigh.
he term “femoral vein,” previously called the “supericial femoral
vein,” should be used to avoid clinical confusion regarding the
deep versus supericial venous system. 77 he popliteal vein (PV)
represents the continuation of the FV ater its exit from the adductor
canal in the posterior caudal thigh. he PV is located supericial