AIUM Practice Parameter for the Performance of Peripheral Arterial Ultrasound Examinations Using Color and Spectral Doppler Imaging

Journal of Ultrasound in MedicineVolume 40, Issue 5 p. E17-E24 Practice ParameterFree Access AIUM Parameter for the Performance Peripheral Arterial Examinations Using Color and Spectral Doppler Imaging First published: 08 February 2021 https://doi.org/10.1002/jum.15643AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text full-text accessPlease review our Terms Conditions Use check box below share version article.I have read accept Wiley Online Library UseShareable LinkUse link a this article with your friends colleagues. Learn more.Copy URL Share linkShare onFacebookTwitterLinked InRedditWechat Introduction The clinical aspects practice parameter were revised collaboratively among American Medicine (AIUM) other organizations whose members use ultrasound performing peripheral arterial examinations using color spectral imaging (see “Acknowledgments”). Recommendations personnel requirements, written request examination, documentation, quality control, safety vary are addressed by each separately. These parameters intended assist practitioners noninvasive evaluation arteries waveform analysis ultrasound. sonographic examination patients vascular disease will, general, complement physiologic tests, such as pressure measurements, plethysmographic recordings, continuous wave Doppler. In selected cases, tailored is used answer specific diagnostic question. Although it not possible detect every abnormality, adherence following will maximize probability detecting most abnormalities that occur extremity arteries. Indications/Contraindications indications include, but limited to, following: 1. detection stenoses or occlusions segment(s) symptomatic suspected occlusive disease. could present recognized indicators, claudication, rest pain, ischemic tissue loss, aneurysm, embolization.1-18 2. monitoring sites previous surgical interventions, including bypass surgery either synthetic autologous vein grafts.19-25 3. various percutaneous angioplasty, thrombolysis/thrombectomy, atherectomy, stent placement.22, 26-30 4. Follow-up progression previously identified disease, documented stenosis an artery has undergone intervention, aneurysms, atherosclerosis, diseases. 5. perivascular abnormalities, entities arteritis, fibromuscular dysplasia, masses, pseudoaneurysms, dissections, injuries, arteriovenous fistulae, thromboses, emboli, malformations.31-36 6. Mapping before interventions.37-41 7. Clarifying confirming presence significant modalities. 8. Evaluation integrity setting trauma. 9. thoracic outlet syndrome, those positional numbness, tingling, cold hand. 10. Allen's test establish patency palmar arch.42, 43 11. Temporal temporal arteritis and/or localize biopsy diagnosis arteritis.32, 33 Additional uses can include preoperative mapping dialysis access postoperative follow-up. (See Vascular Preoperative Planning Dialysis Access44 Postoperative Assessment Access.45) Qualifications Responsibilities Personnel See www.aium.org Official Statements Standards Guidelines Accreditation Practices relevant Training Guidelines. If sonographer performs should be credentialed accordance policies. Written Request Examination electronic provide sufficient information allow appropriate performance interpretation examination. must originated physician appropriately licensed health care provider under provider's direction. accompanying provided familiar patient's situation consistent legal local facility requirements. Specifications consists gray scale waveforms segments. improve lesions identifying visual narrowing changes seen guide placement sample volume assessment.10 A. Appropriate Techniques Diagnostic Criteria Specific techniques indication, different segments studied, pathology being evaluated. criteria differ between native postprocedural Velocity measurements obtained from angle-corrected longitudinal images. Every attempt made acquire images where angle created direction blood flow beam kept at 60° less. estimates larger angles less reliable. For Doppler, velocity ratio, absolute velocity, pulsatility indices, acceleration time published criteria. One more may used. validated some all (eg, been studied iliac common femoral arteries). Waveform shape, absence turbulence, indications. stenoses, optimized lumen high (typically aliasing) stenotic region. B. Occlusive Disease (Peripheral Disease) Physiologic tests system ankle brachial index (ABI), segmental pressure, frequently initial performed determine identify imaging.1, 36, 46 studies complementary equivalent ABI help evaluate hemodynamic consequences lower A contemporaneous ABI, along imaging, supports findings suggest non visualized if discrepant, helps avoid pitfalls. Representative normal segment(s). Suspected Transverse helpful. Documentation abnormality obtaining cine clips. Angle-corrected proximal at, distal stenosis. sonographer/technologist vessel thoroughly throughout highest peak systolic (PSV). PSV within abnormal segment compared recorded image. 1–4 cm (upstream) because helpful document drop beyond poststenotic disturbed flow/turbulence. Distal well tardus parvus waveform, signs significance. present, collateral branches reconstituted artery. location any diseased occluded also documented. Estimated lengths Gray scale, color, generally indicated below. accessible portion entire interest Lower a. Common b. Proximal deep c. superficial d. Mid e. above knee f. Popliteal PSVs clinically appropriate, external iliac, tibioperoneal trunk, anterior tibial, posterior peroneal, dorsalis pedis performed. Evaluating multiple needed adequately vessel. However, focused certain situations. Upper Subclavian Axillary Brachial innominate, radial, ulnar arch C. Surgical Percutaneous Interventions. Bypass grafts An scan length graft anastomosis, representative graft, anastomosis. imaged conduit contiguous velocity. since low low-resistance otherwise noted imply increased risk occlusion. Endovascular interventions site immediately (downstream) intervention. Stents scanned longitudinally their obtained. distortion luminal outside plaque. All image area intervention stent, mid stent), D. Other soft proximity imaged. region abnormality. Pseudoaneurysms evaluating vasculature adjacent tissues transverse planes, above, puncture punctured several centimeters away skin wound. example, groin area, interrogation plane When pseudoaneurysm identified, overall size sac, residual (in cases partially thrombosed pseudoaneurysm), width communicating channel (neck) techniques. demonstrate “to-and-fro” flow. therapeutic therapy means documenting success.36, 47-50 hematomas differentiated pseudoaneurysms optimization Abnormal communication (arteriovenous fistula) communications. of, Flow fistula recorded, found. draining fistula. particularly useful level communications disturbances often create signals transmitted vibrations (color bruit). aneurysms locations widest diameter aneurysm measured (outer wall outer wall) on short axis lumen. intraluminal thrombus Adequate documentation essential high-quality patient care. contain direct management (both abnormal) Examination. Equipment sonography linear curved array transducer equipped pulsed capability. (Power energy needed.) visualize vessels better resolution than transducers. operate frequency, recognizing there trade-off penetration. This usually frequency 3.5 MHz greater, occasional need lower-frequency transducer. originating conducted carrier 2.5 greater. Quality Control Improvement, Safety, Infection Control, Patient Education Policies procedures related education, infection safety, equipment monitoring, developed implemented AIUM's Practices. ALARA Principle potential benefits risks considered. (as reasonably achievable) principle observed when adjusting controls affect acoustic output considering dwell times. Further details found publication Medical Third Edition.51 Acknowledgments was collaboration College Radiology (ACR) Society Radiologists (SRU). We indebted many volunteers who contributed time, knowledge, developing document. Collaborative Subcommittees Members represent societies final revision parameter. John Blebea, MD M. Robert De Jong, RDCS, RDMS, RVT Gowthaman Gunabushanam, ACR Laurence Needleman, MD, chair S. Pellerito, Jason Wagner, SRU Jill Jones, Clinical Committee Bryann Bromley, James Shwayder, JD, vice Nirvikar Dahiya, Rob Goodman, MBBCh, MBA, BMSc Rachel Bo-ming Liu, Jean Spitz, MPH, CAE, RDMS Stephen Expert Advisory Group George Berdejo, Jospeh Polak, Margarita Revzin, Original copyright 2006; 2019, 2014, 2010. Renamed 2015. References 1Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA guidelines Patients (lower extremity, renal, mesenteric, abdominal aortic): collaborative report Associations Surgery/Society Surgery, Cardiovascular Angiography Interventions, Biology, Interventional Radiology, task force (writing committee develop disease)—summary recommendations. J Vasc Interv Radiol 17: 1383– 1397. quiz 1398. 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