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Vascular surgeon, radiologist

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The procedure for examining the arteries of the upper and lower limbs

Alexey Portnov, medical expert
Last reviewed: 19.10.2021

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The procedure for the examination of the arteries of the lower limb

Research always begins with visualization of the pelvic arteries. Several zones have been identified, the examination of which makes it possible to differentiate physiological and pathological changes. Therefore, there is no need to examine the entire lower limb.

The initial examination includes the external iliac artery, the general femoral artery, the superficial femoral artery, the deep thigh artery, the popliteal artery and the tibia-the anterior femoral artery, the posterior femoral artery and, if necessary, the peroneal artery. When detecting anomalies, it is necessary to examine all the vessels.

The area of bifurcation of the common femoral artery is important, as a place predisposed to the onset of atherosclerotic plaques. If scanning reveals occlusion of the superficial femoral artery - the most frequent localization of the occlusion of the leading canal - further attention should be paid to the deep femoral artery, which is an important collateral for the arteries of the shin. Sometimes it is difficult to trace a vessel below the knee joint due to its small caliber and passing through the lead channel. It is important to analyze the distal vascular segments, since they give information about the state of the proximal parts.

The technique of examination of the arteries of the upper limb

The examination of the arteries of the upper limb always begins at the level of the subclavian artery - this is the place of frequent occlusion, then the axillary and brachial arteries should be evaluated. At a distance of 1 cm distal to the elbow joint, the brachial artery is divided into the radial and ulnar arteries. The proximal and distal sections of both vessels are visible when the arm is positioned in the supination position with easy withdrawal. Note that latching syndromes in the arm can be skipped if the lead is not enough, since typical post-stenotic changes in spectral waves are suppressed in this position.

Dopplerographic measurement of peripheral pressure

It is best to use a unidirectional Doppler constant-wave sensor of pocket size with a frequency of 8 or 4 MHz. First of all, measure the shoulder systolic pressure on both sides using the Riva-Rocchi cuff. Then, using a Doppler sensor, measure the pressure in the ankle area on both sides (during dopplerography, the cuff is 10 cm above the ankle). Then place the Doppler sensor at the ankle to locate the posterior sulcus, locate the dorsal artery of the foot and measure at an angle of 60 ° to the vessel. Avoid strong pressure on the sensor. If the pressure does not fit within normal limits or is not determined at all, find the peroneal artery, which is often the safest vessel and maintains adequate blood supply to the shin.

Results: After measuring systolic pressure, compare the highest values on the ankles and shoulders on each side to calculate the ankle-brachial index (LBI) and shoulder-ankle pressure gradient (PGDD).

Changes in the LIP by more than 0.15 or PGDs by more than 20 mm Hg. Art. During a repeated examination, it is possible to suspect a narrowing of the vessel. This is an indication for the CDS. The pressure drop in the area of the ankles is below 50 mm Hg. Art. Is considered critical (risk of developing necrosis).

LIP = ADL / ADHLETIC. PLGD = ADHLETICSIST - ADLOID
LPI	PLDM	How to interpret
More than 1.2	Less than -20 mm Hg. Art.	Suspicion of sclerosis of Myonkeberg (decrease of the compressibility of blood vessels)
Greater than or equal to 0.97	From 0 to -20 mm. Gt; Art.	Norm
0.7-0.97	From +5 to +20 mm. Gt; art.	Stenosis of vessels or presence of occlusion with good collaterals, suspicion on OPPA
Less than 0,69	More than 20 mm. Gt; Art.	Suspicion of occlusion with poorly developed collaterals, occlusion on several levels

The causes of errors in the Doppler pressure measurement

Overestimation of pressure

Too high position of the upper body
Chronic venous insufficiency
Sclerosis of Monckeberg
Swelling of the ankles
Hypertension

Underpressure

The air from the cuff goes too fast
Excessive pressure on the sensor
Insufficient rest period
Increased pressure in the ankle
Stenosis between cuff and sensor

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