How to check the vessels of the body, indications for such studies. Where is ultrasound of the vessels of the legs done, and what are the indications for ultrasound diagnostics of the arteries of the lower and upper extremities

Ultrasound of the vessels of the upper and lower extremities- one of the most informative, safe, quick ways diagnostics to assess the degree vascular pathology and reveal it to early stages the development of the disease. initial method examination is the upper and lower extremities. Reinforced, this technique has no analogues in terms of studying the pathology of the vessels of the upper and lower extremities.

Principles of vascular ultrasound

The ultrasound method is based on the ability of low ultra-frequency reflections from objects in motion. Analyzing the data obtained by means of ultrasound sensors, a specially compiled algorithm (computer program) builds a graphical representation of the features of blood flow and vascular structure. A number of devices allow you to see a color image of the recorded processes. The movement of blood and the pulsation of the veins and arteries of the upper and lower extremities can not only be seen, but also heard.

The ultrasound method allows you to see the blood flow system and a graphical representation of active processes. Some devices are able to provide a color image of the structures

Ultrasound of the vessels of the lower extremities, and, if necessary, the upper ones is carried out in order to study the blood flow in the arteries and veins. In this case, it is possible to assess how passable the studied vessel is, its diameter, the lumen of the constriction, etc. Unlike x-ray angiography, the image of arterial and venous structures in ultrasonic method It is done non-invasively (without damaging the skin) and without the introduction of contrast agents.
It should be said that the advantages of ultrasound of the vessels of the legs include harmlessness to the patient, since there is no radiation exposure. Therefore, it can be carried out often (if necessary), performed by pregnant women and children.

USDG of vessels lower extremities

Indications for an ultrasound scan of the legs

Ultrasonography is performed if there is a suspicion of changes in arterial or venous circulation caused by varicose veins, trophic disorders or atherosclerotic process.

Indications for performing ultrasound scanning of vessels of the lower extremities:

painful sensations in the calf area (which appear at the end of the day, for their relief, you can pour cool water on your legs or lift them up);
the appearance of heaviness in the legs (especially in the evening);
the appearance of pain in the leg that occurs: when walking (more than three to four kilometers), loads (cycling, roller skating, etc.);
with suspicion of varicose veins of the legs, as well as nodular vascular formations ultrasound of the veins of the lower extremities is performed;
the appearance of swelling of the legs of unclear origin (in the evening);
constantly cold skin of the feet makes you do an examination;
numbness, convulsions in them;
Ultrasound of the vessels of the legs is performed with an increase in the leg in volume;
Availability trophic lesions lower leg skin (eg, ulcers);
research is done when a patient is found the following diseases: hypertension, diabetes (diabetes), as these processes can lead to atherosclerosis;
this examination is done while smoking, as this bad habit can lead to the appearance of atherosclerotic plaques on the walls of blood vessels.

atherosclerotic plaque

Along with this, ultrasound of the vessels of the lower extremities, if necessary, of the upper ones, can be done for prophylactic purposes (as a screening). In order to diagnose the pathology of the vascular bed as early as possible, especially in persons with a predisposition to this (persons of the following professions: truckers, surgeons, athletes).

Ultrasound examination of veins and arteries has no contraindications (practically). The only ultrasound of the lower veins, if necessary - upper limbs, it will be difficult to make a patient who is in serious condition, so in this case is not done.

Ultrasound Capabilities

Ultrasound of the veins of the lower extremities allows you to visualize vessels of various diameters, while you can identify the following manifestations of varicose veins:

the cause of the disease;
expressiveness pathological changes;
failure of venous valves;
thrombotic changes (thrombus size, structure, flotation).

Along with this, ultrasound of the vessels of the lower extremities, in some cases, is performed to study the arteries. In this case, the following arterial pathology can be detected:

atherosclerotic plaques in the arteries;
arterial changes caused by blood clots;
blood flow disorders;
the presence of arterial stenosis, the degree of this change;
arterial aneurysms.

It should be noted that ultrasound of the vessels of the lower extremities is an essential method that can detect pathological changes that lead to circulatory disorders. It is worth adding that modern vascular surgery cannot exist without this research.

Preparing a Patient for an Ultrasound Scan

It should be said that preparation for this examination is not required (there are no dietary restrictions, taking medicines do not stop). It is not recommended to take stimulating drinks on the day of the study: tea, coffee; You should not smoke for several hours before the procedure.

Immediately before the diagnostic manipulation, you should not use ointments, and also be exposed to physical activity.

How is an ultrasound scan of blood vessels performed?

So, before starting this procedure, the patient needs to remove clothes from the area under study (also compression underwear). Before the start of the manipulation, the doctor asks the patient about complaints, the presence and duration of the disease.

It should be added that the survey is usually carried out in horizontal position(lying) the patient on the couch, if necessary - standing. Before the examination, a special gel is applied to the patient's skin, which promotes closer contact between the skin of the subject and the ultrasonic sensor.

Application of a special gel

Research, as a rule, is done within: thirty to thirty-five minutes. Immediately after the examination, the doctor interprets the results and gives a conclusion.

It should be noted that patients may experience numbness of the foot. This may be due to poor blood circulation in the leg. Therefore, in order to identify the cause pathological disorders, of course, it is necessary to conduct an ultrasound of the veins of the lower extremities.

The state of deep veins, the speed and direction of blood flow in them, shows ultrasound of the veins of the lower (if necessary, also of the upper extremities).

Advantages of ultrasound scanning

So to positive moments this beam method relate:

painlessness;
non-invasiveness (no damage to the skin surface, no injections);
ease of examination;
relative cheapness (compared to MR angiography, x-ray angiography);
lack of ionizing radiation;
research is done in real time;
you can do a biopsy (if pathological formations are detected);
good visualization of soft tissues (compared to x-ray angiography).

Ultrasound scanning of the vessels of the legs is completely painless and safe procedure

Disadvantages of Ultrasound Scanning

It can be said that vascular research limbs (upper and lower) has the following negative points:

it is not enough to conduct ultrasound alone to make a diagnosis;
it is not always possible to assess the condition of small-caliber arteries and veins;
the presence of atherosclerotic changes interferes with the passage of the ultrasound wave;
cannot replace angiography (including computer or magnetic resonance);
if the study is done on an old apparatus, then diagnostic value method is low.

It should be said that doctors of ultrasound diagnostics recommend periodically examining blood vessels: arteries, veins for patients with a predisposition to pathology ( professional hazards: hairdressers, taxi drivers, overweight, smoking). This will help reduce the risk of developing diseases of the lower, and in some cases, upper extremities.

Thus, an ultrasound scan to detect vascular pathology of the legs is done in order to detect circulatory disorders. Preparation of the patient for this study is not required. Considering the need complex diagnostics vascular pathology, ultrasound examination do by combining with other radiation and functional methods. Attention! An ultrasound specialist does not make a diagnosis.

Ultrasound of the vessels of the lower extremities is a method using ultrasonic waves that allows you to show the vessels graphically and evaluate the parameters of their condition. In order to analyze the characteristics of blood flow, the property of an ultrasonic wave is used to visualize the picture when reflected from moving objects. shaped elements blood. This technique is called dopplerometry or dopplerography.

Types of ultrasound of the vessels of the lower extremities

1.UZDG (two-dimensional ultrasonic dopplerography)

This study is now used quite rarely due to the emergence of other types of ultrasound of the vessels of the legs, as well as devices of a higher diagnostic level. This type of examination can be used to assess the patency of the veins, the condition of the valves that are in the superficial, deep and perforating veins (provided that the valves have a typical localization).

2.UZDS or USAS (duplex angioscanning)

This combination Doppler study and energy mapping. Simply put, in the case of performing this study, areas of different blood velocity are highlighted in different colors.

Duplex ultrasound of the vessels of the lower extremities is the "gold standard". Only on the basis of this study (except for his own examination), the doctor will be able to make a reasonable diagnosis and prescribe treatment.

It allows you to evaluate:

condition of the walls of arterial and venous vessels
patency of both deep and superficial veins
the nature of the damage to the valves of the veins, the degree of their insufficiency in any localization of the veins
the presence of blood clots, their type and size, the degree of vasoconstriction by them
and determine the cause of the recurrence varicose disease after surgery or sclerotherapy.

3. Triplex ultrasound of vessels and veins of the lower extremities

This is a three-dimensional (3D) study of vessels in color. It - best method examinations for those patients who have problems with the arteries or veins of the legs.
It is especially informative in those cases when you need to most clearly draw up a plan for the upcoming surgical intervention to avoid recurrence or complications after surgery.

Who needs to take this test

You need to examine the arteries of the legs:

with diabetes
if you suffer from high blood pressure whatever the reason for it
if walking is accompanied by pain in the legs
with night pains in the legs, especially when lowering them from the bed it becomes easier
if you suffer overweight body
when smoking
feet get cold quickly normal temperature environment
history of myocardial infarction
transferred operations on the vessels of the legs
elevated blood cholesterol levels

Dopplerography of the venous collectors of the lower extremities is performed in the following cases

leg swelling, especially in the evening
visible varicose veins
leg cramps
if pregnancy is complicated by varicose veins in the legs, swelling, pain
pain in the leg, especially if they are accompanied by an increase in local or general temperature
discoloration of the skin on the legs
trophic ulcers.

How to prepare for an examination

Ultrasound dopplerography of the lower extremities is done without any preliminary preparation. She does not require special diet or stopping drugs that treat your arteries or veins. If you are wearing compression stockings, you will need to remove them during the examination.

How is a Leg Ultrasound Performed?

Inspection of the vessels is carried out first in the supine position, with the legs bent at the knees.
Then the doctor must examine the vessels in vertical position patient.
Before starting the inspection, a little special gel is applied to the legs, which serves to eliminate the interference associated with the ingress of air directly under the sensor.

During the procedure, the doctor manually selects the frequency of ultrasound radiation depending on the depth of the vessels and necessary degree its detail. The most commonly used frequency is 6-12 megahertz. deep veins inspected by low frequency sensors.

How is an ultrasound scan done?

It is best to make an ultrasound of the vessels of the legs where you will not only be given a protocol with numbers and a brief conclusion, but where the phlebologist or vascular surgeon. He, based on the data obtained, will assess the characteristics of the movement of blood through the vessels, and then describe further treatment tactics.

To assess blood flow through the arteries, the following indicators are used:

Vmax - maximum speed blood flow in the artery, which is recorded in systole
Vmin - the minimum speed of blood movement recorded in diastole
RI - vascular resistance: this is the ratio of the difference between the systolic and minimum blood flow velocity to the maximum velocity
PI - pulsation index, is defined almost like RI, but is a more sensitive indicator of changes in the lumen of the vessel
thickness of the inner and middle shells of the vessel (TIM).

For femoral artery TIM should be less than 1.1 mm. When it does not reach 1.2 mm, this is still a borderline value. This indicator is more than 1.3 mm, or an increase in this value by 50% of the same indicator in a nearby area, indicating atherosclerosis.

POI: relation systolic pressure on the tibial artery to the same pressure on brachial artery. It should be approximately equal to 1.0 or slightly more.

There are no such digital indicators for veins. During ultrasound examination of the vessels of the extremities, the prices for which differ depending on various clinics, the doctor evaluates the patency of the venous collectors on the lower leg - deep and superficial, as well as the largest veins passing into abdominal cavity and the pelvic cavity - the iliac and inferior vena cava.

All possible thrombi are visualized, the valve system and the state of communicating veins are assessed. Tests are also carried out with raising the leg, clamping the veins with a tourniquet, which allows you to get an idea about the direction and nature of the movement of blood, the presence or absence of pathological discharges in the opposite direction.

To whom to entrust the execution of the study

Where can I do an ultrasound of the vessels of the lower extremities? This is best done in specialized phlebological centers or on the basis of hospitals that have a department vascular surgery. First of all, about where to go for an ultrasound of the legs, consult with a phlebologist, and not with a general surgeon or therapist.

More credible are not those centers that establish high price on the this study 3000 rubles and more, and those in which the examination and this study are performed by a vascular surgeon or phlebologist. On average, the price for

For really effective treatment vascular disorders at the proper level should be their diagnosis. One of the most popular screening methods for detecting violations of all types of blood circulation in the arteries and veins is ultrasound of the vessels of the lower extremities. This type diagnostics has a rather indicative result, it is absolutely safe and can be used in all cases if there are indications.

Fundamentals of ultrasound examination of vascular structures

The diagnostic principles of the ultrasound method are based on the ability of low-frequency ultrasonic waves to be reflected from moving objects. With the help of special sensors, these fluctuations are recorded and, by the difference in their sum, special computer programs build a graphical image of the blood flow and show the vessels under study. To date, there are ultrasonic devices that can convert the received signals into a color image that can be seen on the monitor screen. If necessary, pulse filling with blood can not only be seen, but also heard in the form of pulsating or smooth uniform noises, which depends on the studied arterial or venous vessel.

Alarms in the definition of indications for diagnostics

Despite its absolute harmlessness, ultrasound of the vessels of the legs, like other diagnostic methods, must be performed according to strict indications. They can be determined not only by doctors, but also by patients themselves. But it is better if everything happens under the supervision of a specialized specialist who compares clinical and instrumental data.

signal about vascular disorders and the need to do research may such complaints:

The appearance on the skin of the legs of dilated veins or asterisks from small vessels.
Swelling of the legs and feet, especially unilateral.
Darkening of the skin of the legs, its thickening or long-term non-healing trophic disorders and ulcers.
Feeling of coldness in the legs and their rapid freezing, despite adequate ambient temperature.
Numbness and crawling sensation.
Pain in the legs when walking, any load and at rest. Most often they are forced to do an ultrasound.
Pale feet.
Reduction of the lower leg in volume with a violation of its trophic parameters (hair growth, muscle tone and strength).
Weakness of the lower extremities in relation to loads.
Darkening and blueness of the fingers or the whole foot.
Muscle cramps in the back of the leg.

Varieties of ultrasonic angioscanning

With regard to the terminology of ultrasound diagnostics of blood vessels, there are specific names that often raise a lot of questions. Any ultrasound examination vascular structures called Doppler. Among her methods for diagnosing circulatory disorders, there are two basic studies that fundamentally differ from each other in their diagnostic capabilities.

Standard Doppler ultrasound is a graphic recording or sound recording of blood flow in the vessel being examined. In this case, a black-and-white image of the nature of the blood flow is obtained in the form of a line. The method allows to carry out dopplerometry (description of the characteristics of the obtained image) and draw conclusions about the features of the blood supply to the studied segments of the legs. Mainly used for diagnostics arterial diseases lower limbs. The advantage of this ultrasound technique is the ease of implementation and the possibility of conducting it at the patient's bedside due to the presence of portable devices.
Duplex angioscanning - obtaining a color image of blood vessels depending on the speed and direction of blood flow. This method is more accurate and gives almost comprehensive information about his condition. Pleases him relatively low price compared to other similar informative methods.

What does vascular ultrasound show

Thanks to Doppler ultrasound, one can get an idea only of the function of the vessels - the intensity and nature of the blood flow in them. It is impossible to obtain direct information about its structure. This has to be judged indirectly, evaluating the results obtained and determining the presumptive localization of pathological changes inside its lumen, if any, according to the results of Doppler ultrasound.

Duplex mapping evaluates not only the functional ability, but also directly shows the image of the vessel in those places where there is an obstruction to normal blood flow. It can be used to determine the presumptive cause of the narrowing of the lumen: spasm, atherosclerotic plaque, thrombus, thromboembolism (a blood clot that has come off the heart or aorta and migrated to peripheral vessels lower extremities), external compression by the tumor.

Vascular network on the legs - an indication for ultrasound of the lower extremities

Ultrasound for diseases of the veins of the lower extremities

The method is indispensable for this pathology, since there are no analogues that could replace it. Ultrasound allows you to fully establish the signs:

Varicose disease.
Thrombophlebitis (formation of blood clots in superficial veins).
Phlebothrombosis (thrombosis in the deep venous system).
Chronic venous insufficiency.
Insufficiency of the valvular apparatus of the veins of the perforating and deep systems, and to mark them before surgery, which is possible only with ultrasound of the vessels of the legs.

Ultrasound in the diagnosis of arterial pathology of the legs

In all cases of violation arterial circulation lower extremities need to do an ultrasound. Primary examination performed using dopplerography. Its only competitor is arteriography, which gives even more full information about vascular system legs. But, given its invasiveness and the complexity of its implementation, Doppler ultrasound is indispensable, especially duplex study. It is impossible to overestimate its importance in diagnostics:

Obliterating atherosclerosis and endarteritis.
Diseases of the aorta.
Thrombosis and thromboembolism of the arteries of the lower extremities.
Chronic arterial insufficiency.
Aneurysms of peripheral arterial vessels legs.
Raynaud's disease.

From this article, you will learn how ultrasound of the vessels of the lower extremities is performed, to whom the procedure is prescribed. What can be diagnosed with ultrasound.

Doppler ultrasonography is ultrasound. This diagnostic method, unlike other methods of examining blood vessels, is able to show the speed of blood flow, which allows you to accurately diagnose the severity of the disease that disrupts blood circulation.

For any vessels, this procedure is carried out according to the same principle - using an ultrasound sensor, like any ultrasound. More often this procedure is required to examine the veins, it is used less often to examine the arteries.

Different doctors can refer you to this examination: therapist, phlebologist, angiologist. Performed by a specialist ultrasound.

Indications

Ultrasound of the vessels of the legs is prescribed for the diagnosis of such diseases:

What are the symptoms of ultrasound

Patients are referred to this diagnostic procedure for suspected vascular diseases legs. Your doctor may order an ultrasound scan if you experience these symptoms:

swelling of the legs;
heaviness in the legs;
frequent blanching, redness, blue of the legs;
goosebumps, numbness in the legs;
pain when walking less than 1000 meters;
cramps in the calf muscles;
vascular "asterisks", "grids", protruding veins;
tendency to freeze feet, cold feet even when warm;
the appearance of bruises on the legs even after the slightest blow, or for no reason at all.

When Doppler Ultrasound Is Needed?

Undergo dopplerography of the vessels of the legs as a preventive measure once every six months or a year if you are at risk. To diseases of the vessels of the lower extremities are prone to:

overweight people;
busy physical labor(loaders, athletes);
those who constantly stand or walk a lot at work (teachers, security guards, couriers, waiters, bartenders);
those who have already been diagnosed with atherosclerosis of other vessels;
people whose direct relatives suffered from vascular diseases;
those with diabetes;
smokers;
people over 45;
women during pregnancy and menopause;
women taking oral contraceptives for a long time.

Training

The procedure does not require any complex preparation.

The only thing is that the feet must be clean. If you mean individual characteristics thick hairline on the legs, it is advisable to shave it to make it easier for the doctor to work.

On the day of the procedure, do not drink alcohol, stimulating drinks (coffee, strong tea, energy drinks), do not exercise your legs (do not run, do not lift weights, do not go to training). Do not smoke 2 hours before ultrasound of the vessels of the lower extremities (and other vessels too). It is better to go for examination in the morning.

Take some paper towels or towels with you to dry your feet afterwards. Also bring a referral for an ultrasound scan from your doctor and the results of previous vascular examinations.

How the study is done

First, you free your legs from clothing.

The examination will be performed standing or lying down. The doctor applies an ultrasound gel and moves the ultrasound probe over the legs.

The image of your vessels is displayed on the specialist's monitor. Immediately in the course of the procedure, it analyzes and records the received data.

If you are being examined lying down, the doctor will first tell you to lie on your stomach and raise your legs up on your toes. Or you can put a roller under the feet. In this position, it is most convenient for a specialist to examine the popliteal, peroneal, small saphenous and sural veins, as well as the arteries of the back surface of the legs. Then you will be asked to roll over onto your back and bend your legs slightly in knee joints. In this position, the doctor can examine the veins and arteries of the front surface of the legs.

Anatomy of the leg veins. Click on photo to enlarge

During an ultrasound scan to detect reflux (reverse blood discharge), the doctor can perform special tests:

Compression test. The limb is compressed and the blood flow in the compressed vessels is assessed.
Valsalva test. You will be asked to inhale, pinch your nose and mouth, and strain a little while trying to exhale. If there is initial stage varicose veins, reflux may occur during this test.

Dopplerography of vessels in total takes about 10-15 minutes.

At the end of the examination, you wipe your legs from the remnants of the ultrasound gel, get dressed, pick up the result and you can go.

What does ultrasound of the vessels of the legs show

Using Dopplerography of the lower extremities, you can examine the following vessels of the legs:

During this diagnostic procedure the doctor can see:

the shape and location of the vessels;
vessel lumen diameter;
condition of the vascular walls;
condition of arterial and venous valves;
the speed of blood flow in the legs;
the presence of reflux (reverse discharge of blood, which often occurs with varicose veins veins);
the presence of blood clots;
the size, density and structure of the thrombus, if any;
the presence of atherosclerotic plaques;
the presence of arteriovenous malformations (connections between arteries and veins, which should not normally be present).

Norms of UZDG, conclusion with explanations

The veins should be passable, not dilated, the walls should not be thickened. The lumen of the arteries is not narrowed.

All valves should be consistent, there should be no reflux.

The blood flow velocity in the femoral artery averages 100 cm/s, in the arteries of the leg - 50 cm/s.

Atherosclerotic plaques and blood clots in the vessels should not be detected.

Pathological connections between vessels are normally absent.

An example of a normal conclusion of an ultrasound scan of the veins of the legs and explanations for it

Conclusion: all veins on both sides are passable, compressive, the walls are not thickened, the blood flow is phasic. No intraluminal structures were identified. Valves are wealthy at all levels. There are no pathological refluxes during compression tests and Valsalva tests.

Theses from the conclusion	What do they mean
All veins on both sides are passable, compressive, the walls are not thickened.	All veins on both sides are passable, which means that blood can flow freely through the vessels. Compressive - that is, they have not lost their natural tone, they can shrink. The walls are not thickened - this indicates that there are no inflammatory and other pathological processes.
The blood flow is phasic.	The blood flow is phasic - faster on exhalation and slower on inspiration. This is how he should be.
No intraluminal structures were identified.	Intraluminal structures were not revealed - there are no atherosclerotic plaques, blood clots and other inclusions that should not be there.
Valves are wealthy at all levels.	The valves are well-founded - that is, they normally perform their functions and do not allow backflow of blood.
There are no pathological refluxes during compression tests and Valsalva tests.	There are no pathological refluxes during the performance of the tests - the blood is under no circumstances discharged in the opposite direction, which indicates a healthy blood circulation.

Contraindications

Dopplerography of the vessels of the lower extremities is an absolutely safe procedure. It has no contraindications and age restrictions.

It can be performed at any frequency and for any people, including:

children of any age;
the elderly;
people with chronic diseases;
patients with acute inflammatory diseases;
those who have a pacemaker implanted (they can direct the ultrasound probe to their legs, and ultrasound of the organs chest cavity cannot be done);
pregnant and lactating women;
those who are allergic to contrast agents(angiography, for example, cannot be performed in this case);
people weighing more than 120 kg (but it is impossible to conduct an MRI scan for obese patients on most devices, since they are not designed for such dimensions).

The only restriction that can be tolerated is an allergy to the ultrasound gel. She meets in isolated cases. And she is not absolute contraindication to perform diagnostics. allergic reaction can be avoided by choosing hypoallergenic gel which is right for you.

Gel for ultrasound

Summary, advantages of the procedure

Dopplerography of the vessels of the lower extremities is an absolutely painless diagnostic method. It doesn't evoke any side effects and has no contraindications (with the exception of allergy to ultrasound gel). According to scientists' research, ultrasonic waves do not cause any harm to the body, so ultrasound of the vessels of the legs can be performed at any frequency.