Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  23

PERIPHERAL ARTERIOGRAPHY

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A peripheral angiogram is a test that uses x-rays and dye to identify narrowed or blocked areas in one or more of the arteries that supply blood to the legs. The test is also called a peripheral arteriogram. The angiogram helps determine if a surgical procedure is needed to open the blocked arteries. Peripheral angioplasty uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is generally placed in the artery after angioplasty to help keep it open. Bypass surgery is another procedure. It reroutes blood around the blocked arteries. Duplex Doppler ultrasonography involves the use of high-frequency sound waves to image vessels and evaluate blood flow in the major vessels of the trunk (heart and intra- abdominal organs) and extremities (arms and legs) and in the extracranial cerebrovascular system (neck). This noninvasive test shows the speed, direction, and patterns of blood flow and is used to detect narrowing or blockages in arteries and veins. A handheld transducer directs high-frequency sound waves to the artery or vein being tested. The sound waves strike moving red blood cells and are reflected back to the transducer at frequencies that correspond to blood flow velocity through the vessel. The transducer then amplifies the sound waves to permit direct listening and graphic recording of blood flow patterns. Pulse volume recorder testing may be performed along with duplex Doppler ultrasonography to yield a quantitative recording of changes in blood pressure in an extremity. Normally, venous blood flow fluctuates with respiration, so observing changes in sound wave DOPPLER ULTRASONOGRAPHY

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Patient’s left leg

Patient’s right leg

KEY: a = Lateral circumflex femoral artery b = Medial circumflex femoral artery c = Femoral artery d = Descending branch of the profunda femoris artery e = Profunda femoris artery f = Femoral artery

frequency during respiration helps detect venous occlusive disease. Compression maneuvers can help detect occlusion of the veins as well. Abnormal images and Doppler signals may indicate plaque, stenosis, occlusion, dissection, aneurysm, carotid body tumor, arteritis, and venous thrombosis.

Doppler of Popliteal Artery

The image at right shows a color flow duplex image of a popliteal artery with normal triphasic Doppler signal.

Reprinted with permission from Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing . 13th ed. Philadelphia: Wolters Kluwer; 2013.