Angiogram

Jess: The stenosis would be in the mid-thigh region or the mid-SFA. You can predict the ABI with one level of stenosis. I think the claudication would be distal to the stenosis towards the calf. Danielle: The stenosis is in the left femoral artery mid-distal region. You could predict the ABI if there was one just level of stenosis but if there was more than one and you wanted to know where it exactly was you would want to use segmental pressures because that obtains the most accurate BP for that segment. If the stenosis was in the femoral artery then I would guess that the patient would be having claudication distal to this point, in the left calf.
 * Michelle: where is the stenosis? Can you predict this patient's ABI if there was just one level of stenosis? Where would their claudication be? **

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Michelle: What's the story here? Can you see the left vertebral artery? Look at the lack of contrast filling. As sonographers what will you be lookin for? How about the proximal ICA"s did you see that? Madeline: It looks like subclavian steal maybe? There is a stenosis in the left subclavian, and I say it looks like steal because even though there is a complete break in the picture for the left subclavian, blood flow still seems to get down into the arm further. I don't know though. That's just a guess. As sonographers if it were subclavian steal you would want to look for reversed vertebral flow.  Tatyana: I think there are multiple pathologies on the left side. It looks like there is an occlusion/near occlusion of the left subclavian artery, and also stenosis of the left vertebral artery and maybe occlusion/near occlusion of the left proximal ICA. As sonographers we would be looking for high velosities in case of the stenosis, and no flow or trickle flow in case of occlusion/near occlusion, and of course if there is a left subclavian steal we would expect to see a retrograde flow in the left vertebral artery.

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Michayla: There appears to be a severe stenosis in the proximal internal carotid artery present. = Occlusion or high grade stenosis? =  [] Jess: I think this is an occlusion. You can't see the left CCA at all coming of the arch. McKenna; There is an occlusion seen here. The left CCA is not coming off the arch, but you can see it above which would indicate an occlusion. Any comment?

Michelle: Where is this? What's going on? Emily: This is located near the knee. The mid to distal portion of the left Femoral Artery and left Popliteal Artery are occluded. There has been collateral formation. The right mid Femoral Artery looks like it is stenotic.

Madeline: I agree with Emily, except from this picture it's hard to say that the popliteal is occluded because it is so high above hunter's canal. I do agree that it is the distal femoral artery on the left leg, and it is pretty cool to see the collaterals forming. It also kind of looks like the right leg is starting to form collaterals from that stenosed area which probably means that is //not// an acute stenosis and instead formed over time.

All of this fun anatomy!!!

Jen: In this image, I am seeing occlusion of the right popliteal artery at the knee. There is a lot of small surrounding vasculature in the right compared to the left, maybe indicating collaterals that have formed over time as a result of this stenosis or developing occlusion.

The above 4 images are from:
 * @http://www.rjmatthewsmd.com/Definitions/peripheral_vascular_disease.htm

JENNIFER: label a-g []

Ashley: a. popliteal artery (rt leg) b. anterior tibial artery c. tibioperoneal trunk d. peroneal artery e. posterior tibial artery f. posterior tibial artery g. peroneal artery


 * Fibromuscular Dysplasia of the ICA** (Michayla)

This image is obtained from: __http://www.cardiovascularultrasound.com/content/2/1/7/figure/F1__

__**Ashley: MRA of subclavian steal **__



__Ashley: This image was obtained from :__ http://neuroradiologyonthenet.blogspot.com/2006/01/subclavian-steal-syndrome-sss.html So, based on this MRA, what would we expect to see abnormal sonographically? Tatyana: Based on the image above, we would expect to see a retrograde flow in the left vertebral artery, and an antegrade flow in the right vertebral artery

Jen: This is the most common side of subclavian steal. In the ipsilateral vertebral artery, we will see retrograde flow to supply the left arm with blood. If this occlusion develops over time, the first sonographic sign of this would be the "bunny sign", then the waveforms showing occult steal with exercise of that arm. If we were to perform a transcranial Doppler from the suboccipital window, the right vertebral would be normal, or away from the transducer, and the left vertebral would be reversed, going toward the transducer. Great image!