Basic steps for lower limb doppler examinations.

1. Lower limb doppler examination:
The essentials
Dr/Ahmed Bahnassy
Consultant Radiologist
MBCHB-MSc-FRCR(UK)

2. Aim of the lecture
• Outlining the technique of peripheral
doppler examinations.
• Diagnosing deep vein
thrombosis,without pitfalls.
• Recognizing the other causes of limb
pain.
• Understanding how doppler can
diagnose and grade arterial stenosis.

3. physics basics of doppler(revision)

9. First step:recognize the vessels

10. avoiding pitfalls
femoral nerve
lymph node

11. Avoiding pitfalls :femoral hernia

12. Avoiding pitfalls
great saphenous vein dilated

13. Second step:apply compression
avoid too much
pressure

14. normal compression in lower level

15. skip compression on deep vessels
external iliac vein
thrombosis
EIA with catheter

16. Third step:follow the anatomy

17. Popliteal vein examination

18. Leg veins..12 veins
20%of massive PE will come from them
20% will propagate to CFV

19. Difficult segment analysis:distal
SFV
manual compression

20. changing the probe frequency

21. change your approach

22. Compression

23. Criteria of diagnosis of DVT
expansion-Uncompressibility-
thrombus -absent flow waves-no
augmentation

25. Thrombosis on catheter

26. thrombosed medial limb of
duplicated SFV

27. Occlusive thrombus

28. Subocclusive (partial) thrombus

29. Floating thrombus

30. M-mode use
external iliac vein foating thrombus with M-
mode

31. Mobile thrombus

34. remote effect on peripheral veins

35. proximal pathological process

36. proximal pathological lesion

37. proximal non pathological cause

38. compression by lymph node

39. femoral hernia

40. pseudoanurysm pressure effect

41. haematoma

42. haematoma

43. muscular cause of limb pain

44. muscular cause of limb pain

45. muscle tear and haematoma

46. Baker cyst..problems of evaluation

49. Baker cyst appearances

50. ruptured Baker cyst

51. arterial problems

52. superficial vein problems

53. Post-phlebitic syndrome

54. Tennis leg

55. Tennis leg

56. soft tissue mass

57. edema/cellulitis

58. Lymphedema

60. arterial evaluation
calcific plaques

61. the first jump:spectral evaluation

62. I-basic descriptions

63. basic descritions

64. Basic descriptions

65. II-Types of resistance

66. III-wave patterns

67. wave shape and disease

68. Second jump :meaning of wave

69. flow wave meaning

70. stenosis and monophasicity

71. Third jump:grades of stenosis

72. spectral window..your window to
diagnose

73. normal

74. stenosis

75. minor laminar flow
disturbance..spectral broadening and
filling in

76. spectral broadening grading

77. stenosis and shape of waves

78. 1.lost triphasicity

79. 2.Lost reversed limb

80. 3.Damped waves

81. 4.spectral filling in

82. 5.lost sharpness

83. 6.Reversed flow

84. 7.High EDV

85. 8.Rounded PSV

86. 9.No flow

87. 10.High PSV

88. fourth jump:Stenosis estimation

91. Increased reversed wave

92. Loss of arterial elasticity

93. Systolic flow acceleration

94. Turbulant flow

96. Spectral broadening

97. highly turbulent flow

98. severe stenosis

100. more severe case

101. Aliasing ..a blessing or curse

106. adjustement

107. Fifth jump:Reporting