Chapter 23 - Ultrasound Evaluation of the Peripheral Vascular System


Video 23-1. Venous thromboembolism. Long-axis view of sapheno-femoral junction with thrombus extending from greater saphenous vein into common femoral vein. Note at 18 seconds of this frame the thrombus dislodges and migrates proximally (pulmonary embolism). Patient was carefully monitored for clinically significant sequelae, but none were noted.

Video 23-2. Long-axis view of common femoral vein. Note echogenic intraluminal material (thrombus). It is mobile and not fully adherent to the vessel wall. Color Doppler image demonstrates restricted venous flow around the thrombus.
Video 23-3. Normal Venous Study (Two-Dimensional and Pulsed Doppler).
Time frames:
0:00-0:05 seconds: Compression of common femoral vein in short axis (transverse) plane.
0:06-0:14 seconds: Normal respiratory phasicity in long-axis (longitudinal) view.
0:15-0:18 seconds: Valsalva maneuver resulting in the cessation of venous flow.
0:19-0:27 seconds: Release phase of the Valsalva maneuver resulting in flow augmentation, followed by the return of normal respiratory phases (compare frame 0:06).
0:27-0:30 seconds: Augmentation of venous flow resulting from compression of the calf and the thigh (respectively).
0:31 seconds: End of the video femoral vein compression in short-axis (transverse) view.

Video 23-4. Normal Venous Study (Color Doppler).
Time frames:
0:00-0:07 seconds: Normal venous flow with respiratory variations (phasicity).
0:08-0:11 seconds: Valsalva maneuver resulting in the cessation of venous flow.
0:12-0:20 seconds: Augmentation of venous flow resulting from compression of the calf and the thigh (respectively).
0:20 seconds: End of the video aliasing due to too low filter gate setting (for the venous examination).

Video 23-5. Subclavian vein thrombosis associated with central venous catheter. Note: Mobile echoes at the catheter tip are due to the eddy current from the hypotonic fluid infusion into the bloodstream and can be easily differentiated from the thrombus by the interruption of the intravenous infusion.
Time frames:
0:00-0:10 seconds: Note mobile echogenic material in left subclavian vein.
0:11-0:28 seconds: Intraluminal central venous catheter (hyperechoic), with thrombus adherent to the outer surface.

Video 23-6. Normal (high resistance) pattern of arterial flow. Note triphasic arterial Doppler waveform.
Video 23-7. Abnormal arterial Doppler signal (monophonic).
Video 23-8. High grade stenosis of the artery. Note elevated Doppler flow velocities, marked spectral broadening and signal aliasing of the pulsed Doppler.
Video 23-9. Carotid artery dissection.
Time frames:
0:00-0:10 seconds: Short-axis view demonstrating the false lumen above the true lumen. Note flow is present in both.
0:25-0:41 seconds: Long-axis view of the dissection flap (intraluminal septum).
0:42-1:00 seconds: Color flow image of the dissection (dual flow channels).

Video 23-10. Right common femoral artery pseudoaneurysm.
Time frames:
0:00-0:16 seconds: High-velocity bidirectional Doppler flow signal in the neck of the pseudoaneurysm.
0:17 seconds: End of the video low-velocity “drumbeat” signal in the pseudoaneurysm sac.

Video 23-11. Intra-aortic balloon pump. Internal mammary arterial Doppler flow signal with intra-aortic balloon pump in place to assist with the management of cardiogenic shock with 1:2 ratio. Note diastolic flow augmentation in alternative beats indication proper balloon timing and function.