angle of the ultrasound beam than color Doppler, and it tends to produce a more arteriogram-like vessel image. Although women had smaller arteries than men, peak systolic flow velocities did not differ significantly between men and women in this study. The flow pattern in the center stream of normal lower extremity arteries is relatively uniform, with the red blood cells all having nearly the same velocity. A complete understanding of the ultrasound parameters that are under the examiners control (i.e., color gain, color Doppler velocity scale, pulse repetition frequency or scale for Doppler spectral waveforms, wall filter) is essential for optimizing arterial duplex scans. The posterior tibial vessels are located more superficially (. The hepatic and splenic Doppler waveforms also have this low-resistance pattern. The aorta is followed distally to its bifurcation, which is visualized by placing the transducer at the level of the umbilicus and using an oblique approach (Figure 17-4). Pulsatile high-velocity turbulent flow in lower extremity venous Attention then turns back to the superficial femoral artery, which is followed down to the level of the knee. The iliac arteries are then examined separately to the level of the groin with the transducer placed at the level of the iliac crest to evaluate the middle to distal common iliac and proximal external iliac arteries (Figure 17-5). The https:// ensures that you are connecting to the Locate the anterior tibial vessels by placing the probe transversely over the antero-lateral distal leg supeior to the ankle. Blood velocity distribution in the femoral artery. Locate the popliteal artery at the knee crease in transverse and follow proximally up between the hamstrings, and distally until you see the bifurcation (anterior tibial and tibio-peroneal trunk). Nielsens test involves using a finger cuff perfused by cold fluid. Normal flow velocities for adult common femoral, superficial femoral, popliteal, and tibioperoneal arteries are in the range of 100 cm/sec, 8090 cm/sec, 70 cm/sec, and 4050 cm/sec, respectively (, 6). A complete examination of the aortoiliac system and the arteries in both lower extremities may require 1 to 2 hours, but a single leg can usually be evaluated in less than 1 hour. Occlusion of an arterial segment is documented when no Doppler flow signals can be detected in the lumen of a clearly imaged vessel.
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