What do most people think of today in the first place? What seems to them the most important in life? Of course, health. In the XXI century, cardiovascular diseases are the most common, for their full treatment it is necessary to conduct a comprehensive diagnosis, including examination of arteries and veins.
The article describes how to do ultrasound of blood vessels, what this procedure shows, what vessels are examined using ultrasound.
Ultrasound of blood vessels is the study of the arteries and veins of the body by the ultrasound method. The examination ranks second in frequency after an echocardiography.
The diagnosis of vascular diseases progressed sharply after the introduction of ultrasound devices into medical institutions. Now it is possible to examine the vessels from the inside, without violating the integrity. With the development of new research methods (one-dimensional, two-dimensional, doppler), the quality of visualization and diagnostic accuracy is becoming higher.
The procedure takes place in a darkened room, the person should be in the prone position. Ultrasound of the vessels of the lower limbs is performed when the patient is lying on his stomach. In all other cases, you need to lie on your back.
To improve skin contact, the sensor is smeared with an ultrasound gel. Without it, the air between the skin and the sensor dramatically reduces the visibility of structures.
The survey is always carried out on both sides – left and right. Thus, the degree and symmetry of the lesion is evaluated.
As soon as the doctor has put the sensor on the skin, he begins to look for the vessels necessary for the examination. The specialist sees their layered structure, assesses the size, speed of blood flow, looks at the presence of pathological elements: atherosclerotic plaques, blood clots, separation of the inner layer of the vascular wall.
Consider all of the above only with good visibility. But there are situations when there are difficulties for imaging during ultrasound of vessels:
- Thick layer of subcutaneous fat. In this case, the ultrasound simply cannot sufficiently reach the depth at which the vessel lies.
- Short neck creates certain difficulties in the study. In this case, the vessels are not rectilinear. They are in different planes. For a qualitative diagnosis, the doctor will need some more time.
- Pronounced swelling in the legs also reduces the ability to visualize the vessels, as in the first case.
- The presence of an open wound at the point of projection forces the doctor to look for other places to detect the arteries or veins of this area.
Each person is an individual, and each must be adapted to conduct a full examination, as much as possible answering the questions of the attending physician.
Types of examination
In humans, a huge number of vessels: arteries and veins of different diameters, arterioles, venules, capillaries. They permeate every organ, structure, delivering nutrients with blood and taking away the waste products of cells.
Unfortunately, not every one of them can be seen on ultrasound. Only large and medium diameter vessels are subject to this examination. Capillaries and previous venules and arterioles cannot be visualized by the device.
Most often, doctors prescribe an examination:
- Lower limbs.
- Hearts (much less).
Ultrasound of neck vessels
The patient is asked to lie on his back and slightly raise his chin, sometimes turn his head to the side. The doctor examines in order:
- Common Carotid Artery (OCA).
- Its bifurcation (the place of division into the internal and external carotid arteries). It is in this place that atherosclerotic plaque is most often found.
- External carotid artery.
- Internal carotid artery to the point of entry into the skull.
- The vertebral artery (PA) in the first two segments – before its entry into the spine and in the processes of the vertebrae.
- Subclavian artery.
- Places of discharge of the common carotid and vertebral artery on the left.
- Brachycephalic trunk on the right and its bifurcation on the OCA and PA.
- Jugular veins.
Of course, if pathology is detected during an ultrasound examination of the neck vessels in its lower part, the examination can be extended to the upper extremities.
Ultrasound examination of cerebral vessels
It is always carried out together with the previous one. It allows to evaluate the blood flow in the brain, the structure of the Circle of Willis – the system of arteries forming the alternate paths of blood flow to the brain. Even if one artery is out of order, nothing will happen to the brain, because others will compensate for everything completely. Specialists try to visualize this system of arteries.
For ultrasound of cerebral vessels use an access point with the thinnest bone plate – the temple, and the smallest sensor – sector. During the study, the doctor draws the entire circle of the Willis or the main arteries alternately if they are not in the same plane.
Mainly specialists examine the anterior, middle and posterior cerebral arteries and the anterior, posterior communicating arteries. Each assesses blood flow velocity in all segments and the index of resistance to blood flow. The doctor also draws attention to the symmetry of the indicators on both sides.
Sometimes a specialist can not bring any artery. This is not due to his low professionalism. This happens due to the special properties of bone tissue. In this case, he tries to visualize them from the opposite side, but this is not always possible due to the large depth of the vessels.
In the brain, it is also important to trace the course of the vertebral arteries, which merge into the main artery. The suboccipital fossa is used as a “window”. Ultrasonography of cerebral vessels is performed first lying, then standing. The same indicators are evaluated as in the study of the temporal access and changes in blood flow during verticalization of the patient.
Since the two methods described above are always performed by a pair, the indications for their use are the same:
- noise in ears;
- high blood pressure;
- transient ischemic attack;
- convulsions (suspected epilepsy);
- vestibular disorders;
- cerebral ischemia;
- vertebro-basilar insufficiency;
- coronary heart disease;
- atherosclerosis of any localization;
- injury to the soft tissues of the neck;
- sudden blindness.
Examination of the vessels of the lower extremities
Diseases of peripheral arteries and veins stand out a bit apart, but they have a tremendous frequency of occurrence among the population. This is due to the absence or insufficiency of prevention of this pathology. Ultrasonography of the lower extremity vessels allows to determine the cause of symptoms associated mainly with walking.
Immediately before the test, whether it is a vein or artery, it is necessary to remove all clothing below the belt, including socks, except for underwear. Next, the patient lies on his back and fulfills all instructions of the doctor.
During the study, a specialist evaluates the condition of the arteries and veins. Arteries are examined for atherosclerosis, thrombosis. When the vessel is blocked, already in the area of the inguinal fold to search for the upper limit of the lesion, the study moves to the abdominal region, so the aorta or the inferior vena cava may be affected.
The blood flow is checked without fail. If atherosclerosis of the arteries is suspected, the doctor will need to measure the pressure on the legs to determine the ankle-brachial index (ABI). A cuff is applied to the lower part of the thigh or the upper part of the lower leg, into which air is forced. At this time, the doctor monitors the blood flow with a sensor. When the pulsation stops, the corresponding figure on the tonometer remembers and starts measuring on the next artery. So the doctor must calculate the ABI at least 4 times on both legs – by the number of arteries in the lower leg.
If you suspect a venous thrombosis, ultrasound is performed very carefully. In their normal state, it is necessary to compress the vessels with a sensor and carry out the test with breath-hold and subsequent straining. This verifies the functionality of the venous valves. If there are signs of a thrombosis with an isolated apex in the lumen, then such a diagnosis cannot be carried out, since there is a possibility of tearing off a part of the thrombus with a subsequent embolism of the pulmonary artery.
Indications for ultrasound of the lower limb arteries:
- cold lower limbs;
- pallor of the skin on the legs;
- lack of pulsation of the arteries on the foot;
- pains in the calf muscles when walking;
- weakness in the legs;
- long time non-healing wounds, ulcers on the legs;
- blackening of skin on the foot;
- long smoking experience;
- high blood cholesterol.
Indications for vein examination:
- massive swelling in the legs, often asymmetrical;
- local redness of the skin on the legs;
- the presence of brown pigmentation and coarsening of the skin in the region of the legs;
- suppurations on the leg;
- pain in the leg at rest;
- feeling stiff in the leg;
- enlarged saphenous veins.
For normal operation, the heart needs uninterrupted blood supply, for which the coronary or coronary arteries are responsible.
In addition, large vessels depart from the heart: the pulmonary trunk, the aorta, the inferior and superior vena cava, the pulmonary veins. There are 2 ways to conduct ultrasound of heart vessels:
- Transthoracic – through the chest. Combined with ultrasound of the heart. During the procedure, a specialist examines the main trunks, departing from it and carrying blood to it. These are the aorta, pulmonary trunk, hollow and pulmonary veins.
- Intravascular ultrasound allows inspecting the coronary arteries feeding the heart muscle from the inside. Diagnosis is carried out in conjunction with coronary angiography. A miniature ultrasound transducer is inserted through the conductor and, under the control of an x-ray machine, is advanced to the coronaries. The survey allows in the smallest detail to study the vessel walls, to determine the shape of the plaque, its composition. In addition, it is the best method of visualization and control during stenting or balloon dilatation (methods for expanding the lumen of arteries affected by the pathological process). This method is actively used throughout the world by heart surgeons, x-ray surgeons. In our country is not so common.
Indications for ultrasound of heart vessels (intravascular diagnosis):
- assessment of arterial stenosis;
- evaluation of the functioning of the shunts;
- control endovascular operations.
After an ultrasound of the vessels, the specialist completes the examination protocol. There must be sizes, speeds, indexes. The detected pathology is described in as much detail as possible to determine the dynamics after treatment. What does vascular ultrasound show and what conclusions can be seen in the protocol?
Atherosclerotic changes of varying degrees are detected in the arteries of any diameter. This may be just a thickening of the CMM (middle and inner layer of the wall) or plaque. In the presence of the latter, the degree of stenosis is measured as a percentage, and the change in blood flow is indicated before and after the narrowing of the lumen.
When venous thrombosis is detected, the upper limit is determined, the mobility of the thrombus apex is estimated. Particular attention is paid to the structure of a blood clot, homogeneous or not, whether there are signs of blood flow inside the vessel. So with some probability you can determine the duration of the process and the prognosis of treatment.
Where to diagnose?
Ultrasound is a very common way to detect various diseases, including blood vessels. Ultrasound can be taken in the direction of the attending physician for free in any clinic. But you will most likely have to wait in line for several days or weeks.
If there is a suspicion of venous thrombosis, then the patient is urgently hospitalized in the hospital, where they will conduct all the necessary diagnostics.
But where to do ultrasound of vessels without wasting time and nerves? In any private medical center there is an opportunity to be examined on the same day. You do not need to ask your doctor for this. Naturally, the procedure will be paid.
After the study, the specialist will tell who to contact if there is a pathology, what to expect. In exceptional cases, the doctor calls an ambulance to take the patient to hospital for treatment.