Diagnostic Medical Sonography Program

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Presentation transcript:

Diagnostic Medical Sonography Program Lectures 14 and 15 projects/presentations Preoperative Mapping Procedures Atypical Vascular Disorders

Preoperative Mapping Procedures Epigastric Artery Mapping Internal Mammary Artery Mapping Radial Artery Mapping Vein mapping

Atypical Vascular Disorders Arteriovenous Fistulas (AVF) Treatment of Pseudoaneurysm (PSA) Compartment Syndromes Cystic Adventitial Disease Popliteal Artery Entrapment Syndrome Thoracic Outlet Syndrome (TOS) Arterial Component Trauma

Helpful Hints Arteriovenous Fistula Compartment Syndrome Abnormal connection between high-pressure arterial system and low-pressure venous system, marked anatomic and hemodynamic changes Compartment Syndrome Following repair of a tibial artery (from trauma, occlusion) swelling may be evident. The compartment is bound by bone, fascia and interosseous membrane, which does not allow for expansion.

Helpful hints Treatment of Pseudoaneurysm Ultrasound-guided compression Ultrasound-guided thrombin injection Popliteal artery entrapment syndrome Popliteal artery possibly compressed by medial head of gastrocnemius muscle or fibrous bands Preoperative arterial mapping Epigastric artery Internal mammary artery (internal thoracic Artery) Radial artery mapping

Helpful Hints Preoperative vein mapping Determine suitability for use as extremity or coronary bypass Determine suitability of veins for use in dialysis access grafts Thoracic Outlet Syndrome (arterial component) Occurs with neurovascular bundle compression by shoulder structures (cervical rib, clavicle)occurs in certain arm positions

Helpful Hints Trauma Arterial injuries can result form blunt trauma

Additional Notes: Compartment syndrome Injury in the anterior muscular compartment. Swelling causes the arteries to compress. Fasciotomy is done to release the pressure.

Pseudo-aneurysm (PSA) Take note of the contraindications. Popliteal artery entrapment syndrome Flow to the great toe is monitored with an end point detector, such as a PPG. Planter flexion. Preoperative arterial mapping. Epigastric Artery and Internal Mammary artery (Internal Thoracic artery) mainly used for breast re-construction and CABG (coronary artery bypass grafting). The deep superior epigastric artery is the terminal branch of the internal mammary artery.

Radial artery Mapping For CABG (Coronary Artery Bypass Graft) Measure diameter for the radial artery- acceptable diameter is about 2-3 mm. Preoperative vain mapping GSV and sometimes the Short Saphenous Vein are used in the LE Cephalic and Basilic (superficial veins) are mapped. Proximal tourniquet is used to see how big a vein can get. Want it to expand to handle the high velocity and pressure of an artery.

Acceptable diameter for bypass veins is 2-3 mm. Thoracic Outlet Syndrome Most symptoms are due to neurogenic compression of brachial plexus. A small percentage due to subclavian vein or artery compression. PPG is placed on the digits. Normal wave reflection vas abnormal dampened wave.

TEXT BOOK REFERENCE Chapter 15: Preoperative Mapping Procedures Pages 159 – 164 Chapter 16: Atypical Vascular Disorders Pages 165 - 172