Evaluarea Echo-Doppler a arterelor membrului superior
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sunt prezentate succint si scolastic aplicatiile ecografiei Doppler in evaluarea normala si patologica a arterelor membrului superior
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Evaluarea Echo-Doppler a arterelor membrului superior
- 1. Evaluarea Doppler a AA membrului superior Alexandru Andritoiu ESC, Artery Research (Cambridge)
- 2. Background Anatomie vasculara • Topografie • Raporturi AA-VV • • • • • • Doppler Color Spectral (PWD) Power-angio B-flow Contrast (CEUS)
- 3. ANATOMIE
- 4. Common upper extremity arterial anatomy: The ulnar artery supplies the superficial palmar arch, the major source of blood flow to the digits Fig. Common upper extremity arterial anatomy: The ulnar artery supplies the superficial palmar arch, the major source of blood flow to the digits. The radial artery supplies the deep palmar arch, which in turn supplies the dorsal arches of the hand. Stepansky F et al. Radiographics 2008;28:e28-e28
- 5. The superficial palmar arch is formed mainly by the ulnar artery and is completed by the superficial branch of the radial artery. Fig. The superficial palmar arch is formed mainly by the ulnar artery and is completed by the superficial branch of the radial artery. A complete arch is not always present. The superficial palmar arch provides the arterial supply to the digits via the digital palmar arteries. Stepansky F et al. Radiographics 2008;28:e28-e28
- 6. B-mode • Perete fin-ecogen • Calibru normal • Pulstatilitate • • • • • Elementele de semiologie patologica placi stenoza tromboza ocluzie anevrism
- 7. Doppler color • • • • • Permebilitate Calibru normal Directia de curgere Velocitatea Amplitudinea Elemente patologice • • • • • Flux turbulent Absenta fluxului Fistula AA-VV Stenoza/ocluzie Disectie
- 8. VELOCIMETRIE • AA de rezistenta • Profil trifazic • Difera topografic • • • • • • • Elemente patologice Cuantificarea stenozei Ocluzie Hemodinamice Incarcarea din colaterale Amonte/aval de stenoza Sdr. Furt S-V (sten. AS) Sdr. defileului toracic
- 9. INDICATII • • • • • • • • • • Stenoza TBC Stenoza AS Cateterizarea AB Ocluzia AB Embolie distala (Fi A, Sdr. Defileului toracic Evaluarea Fct. Endoteliale Arterite (TAO, B. Raynaud) Fistule AA-VV (dializa) By-pass (patenta/stenoza graftului)
- 10. TBC • Crosa Ao • ACC dr-AS dr • Rar: stenoza semnificativa
- 11. A Subclavie • • • • • Abord: spatiul supra/subclavicular Raporturi cu V Subclavie Flux pulsatil Sediul stenozei ATS Consecinte hemodinamice aval/amonte ATENTIE: AS ABERANTA IN CAZURI PEDIATRICE Se asociaza cu sdr. compresiv al cailor aeriene
- 12. Stenoza AS • Prevalenta: 2-7% • Diferenta TAS >15 mm dr/stg CAUZE: • ATS – placa • B. Takayasu • Dispazia fibromusculara • Radioterapie Relatia cu: • • • Fumatul, HDL-C ATS (BCI, stenoza ACI, BOAP, stroke) • CAD – 0.5-4% • PAD – 18.7% Shadman R et al. J Am Coll Cardiol, 2004; 44:618-623 Gutierrez GR et al. Angiology. 2001;52:189–194 English JA et al.Cathet Cardiovasc Intervent. 2001;54:8–11
- 13. Stenoza AS - Diagnostic • Clinic: difer TAS dr/stg >15-20 mmHg claudicatia bratului • FRCV Imagistica • US • Angio CT/RMN • Angio-standard
- 15. Hemodinamica • In relatie cu localizarea/severitatea stenozei • Local: V max S ampla • Amonte: sdr. Furt S-V • Aval: flux redus: • A axilara • A brahiala • A mamara interna
- 16. Stenoza AS Flux distal: tardut et parvus
- 17. Subclavian steal syndrome • Stenoza/ocluzia AS ipsilaterala cu devierea retrograda a fluxului in AV • Stenoza situata proximal de originea AV • Asimptomatic • Simptome neurologie (ischemie cerebrala) UNILATERAL/BILATERAL DOBANDIT/CONGENITAL Contorni, 1960;Fisher, 1961;Parrott, 1964
- 18. Subclavian steal syndrome Fig. Subclavian steal syndrome. (a) TOF sequence with a saturation band above the section demonstrates absence of signal in the left vertebral artery (arrow). (b) TOF sequence with a saturation band below the section demonstrates signal corresponding to retrograde flow in the left vertebral artery (arrow). (c) Coronal maximum intensity projection (MIP) image from contrast-enhanced MR angiographic study demonstrates occlusion of the proximal subclavian artery (arrow), with reconstitution distal to the origin of a patent left vertebral artery. Stepansky F et al. Radiographics 2008;28:e28-e28
- 19. Modificari precoce ale anvelopei spectrale a AV in furtul S-V • Tipul I (20%) • Tipul II (40%) Kliewer MA et al. Am J Radiol 2000;174:815-819
- 20. • Tipul III (12.5%) • Tipul IV (27.5%) Kliewer MA et al. Am J Radiol 2000;174:815-819
- 21. Furt S-V patent (total) Flux inversat (retrograd)
- 22. Tratament Interventional • angioplastie Chirurgical • By-pass Car-AS • By-pass AS-AS • By-pass axilo-axilar
- 24. By-pass
- 25. Rolul US • • • • Diagnostic – necesita confirmare Angio! Supraveghere post-interventionala Restenoza post-stentare Tromboza graftului Kablak-Ziembicka A et al. Cardiovasc Intervent Radiol 2007;30:894-900
- 26. Tromboza AS Cauze: • Lezarea endoteliului • Stari protrombotice • Efort fizic (compresie musculara) • Sdr. de defileu toracic
- 27. AS in defileul toracic
- 29. Definitie Sdr. coronarian (anginos) aparut la pacientii revascularizati prin by-pass cu a. mamara interna la care se dezvolta stenoza proximala de AS
- 30. Hemodinamica • Flux retrograd in A. mamara interna stg. • Ischemie miocardica in zona revascularizata
- 31. Tratament • Interventional • Angioplastie-dilatarea stenozei AS + stentare • By-pass: • Transpozitie-sunt Car-Subcl distala
- 32. Proteza vasculara • • • • Perete ecogen Material sintetic Lumen Tipuri diferite US – metoda ideala de supraveghere a evolutiei post-operatorii (permeabilitatea/ocluzia trombotica)
- 34. Artera Brahiala
- 35. AB – Doppler color
- 36. AB – anvelopa spectrala
- 37. Indicatii Tromboza Cercetare • Remodelare arteriala • Evaluarea fct. endoteliale
- 38. Tromboza AB • Lezarea endoteliului CAUZE • Cateterizarea AB • Conditii protrombotice: • Trombofilie • Anticonceptionale orale
- 39. Tromboza AB (post-angiografie) Doppler color - Power-angio lipsa semnal vascular
- 40. Anevrism de a. brahiala
Notas del editor
- Figure 1. Common upper extremity arterial anatomy: The ulnar artery supplies the superficial palmar arch, the major source of blood flow to the digits. The radial artery supplies the deep palmar arch, which in turn supplies the dorsal arches of the hand. (Reprinted with permission from reference 13.)
- Figure 3. The superficial palmar arch is formed mainly by the ulnar artery and is completed by the superficial branch of the radial artery. A complete arch is not always present. The superficial palmar arch provides the arterial supply to the digits via the digital palmar arteries. (Reprinted with permission of Wesley Norman, PhD, from The Anatomy Lesson.)
- Figure 5c. Subclavian steal syndrome. (a) TOF sequence with a saturation band above the section demonstrates absence of signal in the left vertebral artery (arrow). (b) TOF sequence with a saturation band below the section demonstrates signal corresponding to retrograde flow in the left vertebral artery (arrow). (c) Coronal maximum intensity projection (MIP) image from contrast-enhanced MR angiographic study demonstrates occlusion of the proximal subclavian artery (arrow), with reconstitution distal to the origin of a patent left vertebral artery.