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

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

4. 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

5. 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.

6. 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

7. 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

8. Helpful Hints
Trauma
Arterial injuries can result form blunt trauma

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

11. 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.

12. 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.

13. 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.

14. TEXT BOOK REFERENCE Chapter 15: Preoperative Mapping Procedures
Pages 159 – 164
Chapter 16: Atypical Vascular Disorders
Pages