What do most people think today in the first place? What seems to them the most important thing 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 tells how the ultrasound of vessels is done, what this procedure shows, which vessels are examined using ultrasound.
Definition
Ultrasound of blood vessels is an examination of the arteries and veins of the body by the ultrasound method. The examination takes second place in the frequency of appointments after echocardiography.
Diagnosis of vascular diseases has advanced dramatically after the introduction of ultrasound machines in medical institutions. There was an opportunity to consider the vessels from the inside, without violating the integrity. With the development of new research methods (one-dimensional, two-dimensional, Doppler), the quality of imaging and diagnostic accuracy is becoming higher.
How do they do it?
The procedure takes place in a darkened room, the person should be lying. An ultrasound of the vessels of the lower extremities 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 lubricated with an ultrasonic gel. Without it, the air between the skin and the sensor dramatically reduces the visibility of the structures.
Inspection is always carried out on both sides - left and right. Thus, the degree and symmetry of the lesion is evaluated.
Visualization problems
As soon as the doctor put the sensor on the skin, he begins to look for the vessels necessary for the examination. The specialist sees their layered structure, estimates the size, speed of blood flow, looks at the presence of pathological elements: atherosclerotic plaques, blood clots, detachment of the inner layer of the vascular wall.
You can consider all of the above only with good visibility. But there are situations when there are difficulties for visualization during ultrasound of blood vessels:
- A thick layer of subcutaneous fat. In this case, the ultrasound simply cannot sufficiently reach the depth at which the vessel lies.
- A short neck creates certain difficulties in the study. In this case, the vessels are not located rectilinearly. They are in various planes. For a good diagnosis, the doctor will need a little more time.
- Severe swelling on the legs also reduces the ability to visualize blood vessels, as in the first case.
- The presence of an open wound at the projection point forces the doctor to look for other places to detect arteries or veins in this area.
Each person is individual, and each must be adapted to conduct a full examination that answers the questions of the attending physician as much as possible.
Types of Examination
The human body has a huge number of vessels: arteries and veins of various diameters, arterioles, venules, capillaries. They permeate every organ, structure, delivering useful substances with blood and taking away the waste products of cells.
Unfortunately, not every one of them can be examined by ultrasound. Only large and medium diameter vessels are subject to this examination. The apparatus will not be able to visualize capillaries and the venules and arterioles preceding them.
Most often, doctors prescribe an examination:
- The neck.
- Heads.
- Lower limbs.
- Hearts (much less often).
Ultrasound of the vessels of the neck
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 the atherosclerotic plaque is most often found.
- External carotid artery.
- The internal carotid artery to the entrance to the skull.
- The vertebral artery (PA) in the first two segments - before it enters the spine and in the processes of the vertebrae.
- Subclavian artery.
- The places of discharge of the common carotid and vertebral arteries on the left.
- Brachycephalic trunk on the right and its bifurcation on the OCA and PA.
- Jugular veins.
Of course, if a pathology is detected during an ultrasound of the vessels of the neck in its lower part, the examination can be expanded to the upper limbs.
Ultrasound examination of cerebral vessels
It is always carried out in conjunction with the previous one. It allows you to evaluate the blood flow in the brain, the structure of the Willis circle - the system of arteries that form the reserve paths of blood flow into the brain. Even if one artery fails, nothing will happen to the brain, because the others completely compensate for everything. It is this system of arteries that specialists are trying to visualize.
For ultrasound of the vessels of the brain , an access point with the thinnest bone plate, the temple, is used, and the smallest sensor is a sector one. During the study, the doctor displays the Willis circle completely or the main arteries alternately if they are not in the same plane.
Basically, specialists examine the anterior, middle, and posterior cerebral arteries and the anterior, posterior, connecting arteries. In each, the blood flow velocity in all segments and the index of resistance to blood flow are estimated. The doctor also draws attention to the symmetry of the indicators on both sides.
Sometimes a specialist can not withdraw a single 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, however, 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”. An ultrasound of the brain vessels is carried out first lying down, then standing. The same indicators are evaluated as in the study from the temporal access and changes in blood flow during patient verticalization.
Indications
Since the two methods described above are always performed in pairs, the indications for their use are the same:
- headache;
- Dizziness
- noise in ears;
- migraine;
- high blood pressure;
- stroke;
- transient ischemic attack;
- convulsions (suspected epilepsy);
- vestibular disorders;
- cerebral ischemia;
- vertebro-basilar insufficiency;
- coronary artery disease;
- atherosclerosis of any localization;
- soft tissue trauma to the neck;
- sudden blindness.
Examination of the vessels of the lower extremities
Diseases of the peripheral arteries and veins are a little different, but have a tremendous frequency of occurrence among the population. The blame for the absence or insufficiency of the prevention of this pathology. Ultrasound of the vessels of the lower extremities allows you to determine the cause of the symptoms, mainly associated with walking.
Immediately before the examination, whether it be veins or arteries, it is necessary to remove all clothing below the waist, including socks, except underwear. Next, the patient lies on his back and follows all the instructions of the doctor.
During the study, a specialist evaluates the condition of arteries and veins. Arteries are examined for atherosclerosis, thrombosis. When the vessel is clogged already in the area of the inguinal fold to search for the upper border of the lesion, the study goes to the abdomen, so the aorta or inferior vena cava may be affected.
The blood flow is mandatory checked. If arteriosclerosis is suspected, the doctor will need to measure leg pressure to determine the ankle-brachial index (LPI). A cuff is placed on the lower thigh or upper tibia, into which air is pumped. At this time, the doctor monitors the blood flow using a sensor. When the pulsation stops, the corresponding digit on the tonometer remembers and begins to measure on the next artery. So the doctor should calculate the LPI at least 4 times on both legs - according to the number of arteries in the lower leg.
If vein thrombosis is suspected, an ultrasound scan is performed very carefully. In their normal state, it is necessary to compress the vessels with a sensor and conduct a test with a holding breath and subsequent straining. This checks the functionality of the vein valves. If in the lumen there are signs of thrombosis with an isolated apex, then such a diagnosis cannot be carried out, since there is the possibility of separation of a part of the thrombus with subsequent embolism of the pulmonary artery.
Indications for ultrasound of lower limb arteries:
- cold lower limbs;
- pallor of the skin on the legs;
- lack of pulsation of arteries in the foot;
- pain in the calf muscles when walking;
- weakness in the legs;
- diabetes;
- long time non-healing wounds, leg ulcers;
- blackening of the skin on the foot;
- long smoking history;
- high blood cholesterol.
Indications for vein examination:
- massive swelling on the legs, often asymmetric;
- local redness of the skin on the legs;
- the presence of brown pigmentation and coarsening of the skin in the lower leg;
- suppuration on the leg;
- leg pain at rest;
- feeling of fullness in the leg;
- dilated saphenous veins.
Heart vessels
For normal operation, the heart needs an uninterrupted supply of blood, for which the coronary or coronary arteries are responsible.
In addition, large vessels depart from the heart: pulmonary trunk, aorta, inferior and superior vena cava, pulmonary veins. There are 2 ways to conduct an ultrasound of the heart vessels:
- Transthoracic - through the chest. Combined with ultrasound of the heart. During the procedure, a specialist examines the main trunks, departing from him and carrying blood to him. This is the aorta, pulmonary trunk, vena cava and pulmonary veins.
- Intravascular ultrasound allows you to examine the inside of the coronary arteries that feed the heart muscle. Diagnosis is carried out in conjunction with coronary angiography. A miniature ultrasonic sensor is introduced through the conductor and, under the control of the X-ray apparatus, it is advanced to the coronaries. The examination allows in great detail to study the walls of the vessel, to determine the shape of the plaque, its composition. In addition, this is the best method of visualization and control during stenting or balloon dilatation (ways to expand the lumen of arteries affected by the pathological process). This method is actively used throughout the world by cardiac surgeons, x-ray surgeons. In our country is not so common.
Indications for ultrasound of the blood vessels of the heart (intravascular diagnosis):
- assessment of arterial stenosis;
- assessment of the functioning of shunts;
- monitoring the implementation of endovascular operations.
results
After ultrasound of the vessels, the specialist fills in the examination protocol. There should be sizes, speeds, indices. The detected pathology is described in as much detail as possible to determine the dynamics after treatment. What does the ultrasound of the vessels show and what conclusions can be seen in the protocol?
In arteries of any diameter, atherosclerotic changes of various degrees are detected. This can be just a thickening of the CMM (middle and inner layer of the wall) or a plaque. In the presence of the latter, the degree of stenosis is necessarily measured as a percentage and the change in blood flow before and after the narrowing of the lumen is indicated.
If vein thrombosis is detected, the upper border is determined, the mobility of the top of the thrombus is evaluated. Particular attention is paid to the structure of the thrombus, homogeneous or not, whether there are signs of blood flow inside the vessel. So with a certain degree of probability it is possible to 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 at any clinic. But most likely you will have to wait your turn for several days or weeks.
If there is a suspicion of venous thrombosis, then the patient is urgently hospitalized in a hospital, where they will conduct all the necessary diagnostics.
But where to do an ultrasound of blood 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 a referral. Naturally, the procedure will be paid.
After the study, the specialist will tell who to contact if there is a pathology, what should be expected. In exceptional cases, the doctor calls an ambulance to deliver the patient for treatment to the hospital.