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Protocol
Tips
Follow the vessels in their entirety in color, taking the appropriate images at the described locations
If abnormalities are seen with color Doppler in any segment of vessel, include a gray scale image of
that segment of vessel to document pathology in gray scale.
With diabetic patients, you may experience trouble getting accurate blood pressures for ABIs due to
calcification of the vessel walls.
Color Doppler
Will vary with the presence/absence of pathology & curvature of the vessel
Color images should relay the same information as your spectral images
Color box should be steered (angled) with the vessel direction
AK\backup\Vascular II\protocols
Lower Extremity Arterial Protocol
Color in a normal vessel should be free of aliasing and extend to vessel walls
Utilize preset color PRF (scale) and gain, and adjust according to the type of blood flow (velocities) being
imaged
If flow is normal and the color is outside the vessel wall or aliasing in center of vessel, slowly
increase PRF and/or decrease color gain until color is no longer outside the vessel wall or
aliasing.
If flow is normal and the color in the vessel is not filled in, slowly decrease PRF and/or
increase color gain until the color fills the vessel without aliasing or bleeding.
Spectral Doppler
Must use angle correct Angle correct must be less than 60 degrees
Gate (SV length) must be in center of vessel & small width.
Use color Doppler appearance to aid in placement of gate for spectral interrogation. Your goal is to
document the highest velocities present.
Set the PRF (scale) appropriately for the velocities imaged.
Adjust the PRF (scale) to display a large waveform.
Adjust the spectral gain so that there is no background noise on the spectral trace.
Normal waveforms in the extremities are high-resistive and triphasic, with a sharp systolic upstroke
followed by a brief period of diastolic flow reversal, ending with minimal forward flow in diastole
Elevated velocities with spectral broadening indicate a stenosis
Record velocities in the stenotic area as well as approximately 2 cm prior to (prestenotic) and after
(poststenotic) the area of stenosis
Stenosis is considered significant if the flow in stenotic area is twice the velocity of an area just
previous (prestenotic) to it
Waveforms distal to a significant stenosis will become monophasic
Pathology Seen
Atherosclerosis (plaque)
o Walls will appear thick
o Calcified plaque will produce acoustic shadowing
o Use color Doppler to evaluate for flow disturbances (aliasing)
Aneurysm
o Vessel diameter will be 1.5 times larger than adjacent more proximal segment
o Measure in sagittal (AP) and transverse (width) from outer wall to outer wall
o Document intramural thrombus in sagittal and transverse with gray scale and color Doppler
Document any soft tissue abnormalities seen in proximity to the arteries.
Document any venous thrombosis seen.
Document any pseudoaneurysms seen (size, residual lumen, and width of communicating channel/
neck).