Doppler examination of the upper limb veins. Doppler ultrasound of the vessels of the lower extremities: an overview of the procedure Spontaneous blood flow

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Tasks instrumental diagnostics CVI.

• Assessment of the state of deep veins, their patency and functions of the valve apparatus.
• Detection of blood reflux through the ostial valves of the great and small saphenous veins.
• Determination of the length of the lesion of the valve apparatus of the trunks of the saphenous veins, as well as clarification of the features of their anatomical structure.
• Identification and precise localization of insufficient perforating veins.

The basis modern diagnostics CVI are ultrasound methods - dopplerography and angioscanning.

Doppler ultrasound is based on the Doppler effect - a change in the frequency of a sound signal when it is reflected from a moving object (in this case, from blood cells). The difference between the generated and reflected waves is recorded as an audio or graphic signal.

The examination is carried out in the horizontal and vertical positions of the patient. The standard "windows" for research are the posterior malleolar region (locate the posterior tibial veins), the popliteal fossa (locate the popliteal and lesser saphenous veins) and the upper third of the thigh (the zone of location of the femoral and great saphenous veins). Spontaneous and stimulated blood flow through the deep and saphenous veins is studied.

Spontaneous (antegrade) blood flow is determined in large veins. Him distinctive feature - connection with respiratory movements chest, therefore, its sound resembles the noise of the wind, which intensifies during the exhalation phase and weakens during inhalation. Stimulated venous blood flow is necessary to assess the functions of the valve apparatus of the great veins. When examining the proximally located vessels (femoral and great saphenous veins), the Valsalva test is used. Have healthy people during inhalation, venous noise is weakened, at the moment of straining it completely disappears, and with subsequent exhalation it sharply increases. The insufficiency of the valves of the examined vein is indicated by the noise of a retrograde blood wave that occurs when the patient is straining.

The condition of the tibia, popliteal and small saphenous veins is assessed using proximal and distal compression tests. In the first case, manual compression of the limb segment is performed above the ultrasound sensor. This increases the intravenous pressure and, in the event of valve failure, a signal of retrograde blood flow is recorded. In a distal compression test, the limb segment is compressed below the transducer. This leads first to the appearance of antegrade, and after decompression, a retrograde blood wave.

Ultrasound angioscanning allows to obtain an image of the examined veins in real time. The value of the study increases with the simultaneous use of Doppler or color Doppler imaging modes. Standard "windows" and samples for the study of the venous system are similar to those described above. Retrograde blood flow is determined by reversing an audio or graphic Doppler signal or by changing the color of blood flow in color mapping.

To date, ultrasound angioscanning is the most informative diagnostic method, which allows visualizing almost the entire venous bed from the veins of the foot to the inferior vena cava. The research results allow with high degree to establish the exact cause of chronic venous insufficiency by discovering the consequences of venous thrombosis in deep veins (vein occlusion or recanalization of its lumen) or, on the contrary, their unchanged wall with wealthy valves. With varicose veins, the length of blood reflux along the trunks of the main superficial veins is determined. In addition, ultrasound angioscanning makes it possible to reliably localize insufficient perforating veins (Fig. 1), which facilitates their search during surgical intervention.

Figure: 1. Ultrasound angioscanogram of a patient with varicose veins. The incompetent perforating vein connecting the deep vein with the superficial one is localized.

Radionuclide phlebography.A distinctive feature of this minimally invasive study is the ability to obtain information about the features of the functioning of the venous bed. lower limbs... The study is carried out in an upright position of the patient. After a tourniquet is applied over the ankles, blocking the lumen of the saphenous veins, a radionuclide is injected into the vein of the dorsum of the foot. Then the patient begins to rhythmically bend and unbend the foot without lifting the heel from the support. This imitation of walking “turns on” the muscle-venous pump of the lower leg, and the radiopharmaceutical begins to move through the deep veins. The detector of the gamma camera registers its movement (Fig. 2), fixing the perforating discharge into the superficial veins, zones of isotope retention (segments with valve insufficiency) or its absence (areas of occlusion). Big diagnostic value has the rate of evacuation of the drug from different parts of the venous bed, which allows one to judge the scale of the violation venous outflow in a particular zone.

Figure: 2. Radioisotope phleboscintigram. A picture of a patient with left-sided iliac vein occlusion. The outflow of blood from the affected limb along collaterals in the suprapubic region is carried out through the right iliac veins.

X-ray contrast phlebography. For its implementation, it is necessary to introduce a water-soluble X-ray contrast agent into the main veins. This method is considered one of the most informative, but at the same time quite traumatic and unsafe for the patient (allergic reactions to a contrast agent, venous thrombosis, hematomas). X-ray phlebography gives the most complete picture of the anatomical and morphological features of the venous bed, so it is still indispensable when planning deep vein reconstructive surgeries (valve plastics, vein transposition, etc.) in patients with post-thrombophlebitic disease. In case of varicose veins, this research method is not currently used, since the information obtained by ultrasound and radionuclide research is sufficient to determine the tactics of treating the patient.

Saveliev V.S.

Surgical diseases

In each case, in addition to examination, we are asked to go through the bridle of the lower limbs. What is this procedure and what diseases can be diagnosed with it?

What is USDG and what is investigated with its help

Doppler ultrasound is an abbreviation for the name of one of the most informative methods of studying blood circulation in vessels - Doppler ultrasound. Its convenience and speed, coupled with the absence of age-related and special contraindications, make it the "gold standard" in the diagnosis of vascular diseases.

The USDG procedure is performed in real time. With its help, the specialist already receives sound, graphic and quantitative information about the blood flow in the venous apparatus of the legs.

• Large and small saphenous veins;
• Inferior vena cava;
• Iliac veins;
• Femoral vein;
• Deep veins of the lower leg;
• Popliteal vein.

When conducting bridging of the lower extremities, the most important parameters of the state of the vascular walls, venous valves and patency of the vessels themselves are assessed:

• The presence of inflamed areas, blood clots, atherosclerotic plaques;
• Structural pathologies - tortuosity, kinks, scars;
• The severity of vascular spasms.

During the study, compensatory blood flow capabilities are also assessed.

When doppler examination is necessary

Overdue problems in blood circulation make themselves felt in varying degrees of pronounced symptoms. You should rush to the doctor if you begin to notice difficulties with footwear, and your gait loses its lightness. Here are the main signs by which you can independently determine the likelihood that you have impaired blood circulation in the vessels of the legs:

• Mild swelling of the feet and ankle joints, appearing in the evening and completely disappearing in the morning;
• Discomfort when moving - heaviness, painful sensations, rapid leg fatigue;
• Convulsive twitching of the legs during sleep;
• Rapid freezing of the legs at the slightest drop in air temperature;
• Cessation of hair growth on the legs and thighs;
• Tingling sensation of the skin.

If you do not consult a doctor when these symptoms appear, then in the future the situation will only worsen: varicose veins, inflammation of the affected vessels and, as a consequence, trophic ulcers will appear, which already threatens disability.

Vascular disease diagnosed by ultrasound

Since this type of research is one of the most informative, the doctor, based on its results, can make one of the following diagnoses:

Any of the diagnoses made requires the most serious attitude towards itself and the immediate start of treatment, since the aforementioned diseases by themselves cannot be cured, their course only progresses and over time causes severe consequences up to complete disability, in some cases even death.

How is a Doppler study performed

The procedure does not require preliminary preparation of patients: there is no need to follow any diet, take drugs other than those that you usually take to treat existing diseases.

When you come for an examination, you need to remove all jewelry and other metal objects from yourself, provide the doctor with access to the legs and hips. The doctor of ultrasound diagnostics will offer to lie down on the couch and apply a special gel to the sensor of the device. It is the sensor that will capture and transmit all signals about pathological changes in the vessels of the legs to the monitor.

The gel improves not only the sliding of the sensor on the skin, but also the transfer rate of the data obtained from the study.

After the end of the examination in a lying position, the doctor will offer to stand on the floor and continue to study the state of the vessels to obtain additional information about the alleged pathology.

Normal values \u200b\u200bwhen conducting USDG of the lower extremities

Let's try to figure out the results of the study of the lower arteries: the udg has its normal values, with which you just need to compare your own result.

Numerical values

• ABI (ankle-brachial complex) is the ratio of ankle BP to shoulder BP. The norm is 0.9 and above. The indicator 0.7-0.9 indicates arterial stenosis, and 0.3 is a critical figure;
• The limiting blood flow velocity in the femoral artery is 1 m / s;
• The limiting blood flow velocity in the lower leg is 0.5 m / s;
• Femoral artery: resistance index - 1 m / s and higher;
• Tibial artery: pulsation index - 1.8 m / s and above.

Types of blood flow

They can be designated as turbulent, main or collateral.

Turbulent blood flow is recorded in places of incomplete vasoconstriction.

The main blood flow is nome for all large vessels - for example, the femoral and brachial arteries. Note “main altered blood flow” indicates the presence of stenosis above the study site.

Collateral blood flow is recorded below the places where there is a complete absence of blood circulation.

The study of the state of blood vessels and their patency by Doppler is an important diagnostic procedure: it is easy to perform, does not take much time, is completely painless and at the same time gives a lot of important information about functional state venous apparatus of the legs.

My great-grandmother had inflammations and blood clots on her legs, they advised her to check her legs using Doppler ultrasound, so I read the article. Everything is well described and told, there are even numerical values \u200b\u200bof the norms. The symptoms are also similar to those presented here, she experiences discomfort when moving, her legs are very sore. I hope for good doctors and that they will help you find out what is wrong with your legs and how it is treated, the main thing is that the correct treatment is prescribed. Good health to all, do not get sick!

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This is normal arterial blood flow (to the arteries).

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Ultrasound scanning of the main arteries of the lower extremities

The study of the main arteries of the lower extremities was carried out in 62 patients using duplex scanning on expert level ultrasound scanners. Ultrasound examination of the lower extremities was also carried out in 15 healthy individuals, who made up the control group

The study of the iliac arteries was carried out with a convex multifrequency probe 3-5 MHz, the femoral, popliteal, posterior and anterior tibial arteries and the dorsal artery of the foot - a linear velocity probe with a frequency of 7-14 MHz (83).

The arterial bed was scanned in the longitudinal and transverse scan planes. Transverse scanning clarifies the features of the anatomy of the arteries in the areas of their bifurcations or bends.

When researching abdominal aorta the sensor was installed at the level of the navel, slightly to the left of the median line, and a stable visualization of the vessel was achieved. Then the sensor was moved to the border of the middle and inner third of the pupar ligament and the iliac arteries are located. Below the ligament, the ostium of the femoral artery was visualized. The common femoral artery (BOTA) and its bifurcation were visualized without difficulty, while the orifice of the deep femoral artery (HDA) can be accessed for examination at a site only 3-5 cm from the orifice. If the mouth of the GBA is located on the side wall, BOTH-sensor was deployed slightly laterally. The superficial femoral artery (PFA) is well traced to the level of the entrance to the Hunter's canal, medially and downward. When examining the popliteal artery (PlA), the sensor was positioned longitudinally in the upper corner of the popliteal fossa, shifting it distally to the border of the upper and middle third of the leg.

The upper and middle third of the posterior tibial artery (TABA) are located from the anteromedial approach between the tibia and the gastrocnemius muscle. To study the distal ZBBA, the sensor was positioned longitudinally in the depression between the medial malleolus and the edge of the Achilles tendon.

The anterior tibial artery (PBBA) is located from the anterolateral approach, between the tibia and fibula. The artery of the dorsum of the foot is defined in the interval between the I and II metatarsal bones.

The screening technique is based on assessing the quantitative and qualitative parameters of blood flow at standard points of the study, where the artery is as close as possible to the skin surface and is associated with certain anatomical landmarks (Fig. 2.11).

Figure 2.11. Standard localization points of the main arteries of the lower extremities.

When changes in the hemodynamic parameters of blood flow were detected at any of the standard points, the arterial bed was examined along the entire length in two projections.

The most difficult for visualization and qualitative assessment of intraluminal changes are the arteries of the foot and lower leg; therefore, the B-mode was used in the study of peripheral hemodynamics. In this mode, it is normal:

• the lumen of the arteries is homogeneous, hypoechoic, does not contain additional inclusions.
• admissible asymmetry of diameters of paired vessels - up to 20%.
• pulsation of the arterial wall.
• complex "intima-media".

Qualitative assessment: smooth, clearly differentiated into layers. Quantitative assessment: its thickness in BOTH is not more than 1.2 mm (Fig. 2.12).

Figure: 2.12. The main type of blood flow is normal in the B-mode of patient L., 37 years old.

To assess the patency of the arteries, in addition to the B-mode, color and spectral Doppler modes were used, and when examining superficial small-caliber vessels, the frequency of the sensor can be increased.

Figure: 2.13. The norm of the CDC of patient L. is 37 years old.

In the color Doppler mapping mode, the lumen of the arteries is stained evenly. Physiological turbulence of the flow is recorded in the bifurcations of the arteries (Fig. 2.13).

Qualitative and quantitative parameters were assessed in the Doppler mode.

• the main three-phase type of blood flow is recorded.
• no spectral expansion, the presence of a "Doppler window"
• lack of local acceleration of blood flow Quantitative parameters.
• diastolic blood flow velocity (Vd)

Indices that indirectly characterize the state of peripheral resistance in the studied vascular basin:

• peripheral resistance index (IR)
• ripple index (IP)
• systolic-diastolic ratio (S / D)

Indices that indirectly characterize the tone of the vascular wall:

• acceleration time (AT); acceleration index (AI) (fig. 2.14).

Figure: 2.14. The main type of blood flow is normal for patient B., 43 years old.

The measured velocity and calculated parameters of blood flow in the study of the arteries of the lower extremities obtained in the control group at the age of 18 to 45 are shown in Table 2.12.

Average linear blood flow velocity and pulse wave acceleration time

Peak systolic blood flow velocity (Vs)

Peak systolic blood flow velocity (Vs)

fig. 1).

2, 3 - vessels of the neck:

OSA, VSA, NSA, PA, YAV;

4 - subclavian artery;

5 - vessels of the shoulder:

brachial artery and vein;

6 - vessels of the forearm;

7 - vessels of the thigh:

10 - dorsal artery of the foot.

МЖ1 - upper third of the thigh;

МЖ2 - lower third of the thigh;

МЖЗ - upper third of the lower leg;

МЖ4 - lower third of the lower leg.

To clarify the topography of the vessels, scanning is performed in a plane perpendicular to the anatomical course of the vessel. With transverse scanning, the interposition of the vessels, their diameter, wall thickness and density, and the state of the perivascular tissues are determined. Using the function and tracing the inner contour of the vessel, the area of \u200b\u200bits effective cross-section is obtained. Next, a transverse scan is performed along the studied segment of the vessel to search for areas of stenosis. When stenosis is detected, use the program<2D процентов Stenosis> to obtain a calculated stenosis index. Then a longitudinal scanning of the vessel is carried out, evaluating its course, diameter, inner contour and wall density, their elasticity, pulsation activity (using the M-mode), and the state of the vessel lumen. Measure the thickness of the intima-media complex (along the far wall). Doppler examination is carried out in several areas, moving the sensor along the scanning plane and inspecting the largest possible area of \u200b\u200bthe vessel.

2 D percent stenosis - percent STA \u003d (Stenosis Area / Blood Vessel Area) * 100 percent. It characterizes the real decrease in the area of \u200b\u200bthe hemodynamically effective section of the vessel as a result of stenosis, expressed as a percentage.

Laminar type is the normal variant of blood flow in the vessels. A sign of laminar blood flow is the presence of a "spectral window" on the Doppler chart at the optimal angle between the direction of the ultrasound beam and the flow axis. If this angle is large enough, then the "spectral window" can "close" even with a laminar type of blood flow.

The main type is a normal variant of blood flow in the main arteries of the extremities. It is characterized by the presence of a three-phase curve on the Doppler pattern, consisting of two antegrade and one retrograde peaks. The first peak of the curve is systolic antegrade, high-amplitude, pointed. The second peak is a slight retrograde (blood flow in diastole before closing aortic valve). The third peak is a small antegrade peak (blood reflection from the aortic valve leaflets). It should be noted that the main type of blood flow can persist even with hemodynamically insignificant stenosis of the main arteries.

The main altered type of blood flow is recorded below the site of stenosis or incomplete occlusion. The first systolic peak is changed, of sufficient amplitude, widened, flatter. The retrograde peak can be very weak. The second antegrade peak is absent.

Collateral type of blood flow is also recorded below the occlusion site. It appears close to a monophasic curve with a significant change in systolic and the absence of retrograde and second antegrade peaks.

The difference between Doppler images of the vessels of the head and neck from Doppler images. extremities is that the diastolic phase on the Doppler images of the arteries of the brachycephalic system is never below 0 (i.e., does not fall below the Base line). This is due to the peculiarities of the blood supply to the brain. At the same time, on Doppler images of the vessels of the internal carotid artery system, the diastolic phase is higher, and the external carotid artery system is lower.

Study of the vessels of the neck

The position of the patient is on the back. The head leans back a little, a small roller is placed under the shoulder blades. The study of the aortic arch and the initial sections of the subclavian arteries is carried out with the suprasternal position of the sensor. The aortic arch and the initial sections of the left subclavian artery are visualized. From the supraclavicular access, the subclavian arteries are examined. Comparison of the indicators obtained on the left and right to identify asymmetry. If occlusions or stenoses of the subclavian artery are detected before the vertebral origin (1 segment), a test with reactive hyperemia is performed to identify the “steal” syndrome. For this, the brachial artery is compressed with a pneumatic cuff for 3 minutes. At the end of the compression, the blood flow velocity in the vertebral artery is measured and the air is drastically released from the cuff. Increased blood flow in the vertebral artery indicates lesions in the subclavian artery and retrograde blood flow in the vertebral artery. If there is no increase in blood flow, the blood flow in the vertebral artery is antegrade and there is no occlusion of the subclavian artery. To study the axillary artery, the arm on the side of the study is retracted outward and rotated. The scanning surface of the sensor is installed in the articular fossa and tilted downward. Compare indicators from both sides. The examination of the brachial artery is carried out when the sensor is located in the medial groove of the shoulder. Systolic blood pressure is measured. The tonometer cuff is applied to the shoulder, the Doppler spectrum is obtained from the brachial artery below the cuff. Blood pressure is measured. The criterion for systolic blood pressure is the appearance of a Doppler spectrum with Doppler. Compare the indicators obtained from opposite sides.

< ПН < 20.

To study the ulnar and radial arteries, the sensor is installed in the projection of the corresponding artery, further examination is carried out according to the above scheme.

The study of the veins of the upper extremities is usually carried out simultaneously with the study of the arteries of the same name from the same approaches.

Study of the vessels of the lower extremities

When describing changes in femoral vessels use the following terminology, somewhat different from the standard anatomical grouping by vessel class:

Study of the femoral arteries. The original position of the sensor is under the inguinal ligament (transverse scan). After assessing the diameter and lumen of the vessel, scanning is performed along the common femoral, superficial femoral and deep femoral arteries. The Doppler spectrum is recorded, the results obtained are compared on both sides.

Examination of the leg arteries. In the position of the patient on the stomach, a longitudinal scan is performed from the place of division of the popliteal artery along each of the branches, alternately on both legs. Then, in the position of the patient on the back, scan the posterior tibial artery in the medial ankle and the dorsal artery of the foot in the dorsum of the foot. Qualitative location of arteries at these points is not always possible. An additional criterion for assessing blood flow is the regional pressure index (RID). To calculate the RID, the cuff is sequentially applied first to the upper third of the lower leg, the systolic pressure is measured, then the cuff is applied to the lower third of the lower leg and the measurements are repeated. During compression, scan a. tibialis posterior or a. dorsalis pedis. RID \u003d systemic BP (lower leg) / systemic BP (shoulder), normal\u003e

The study of the popliteal veins is carried out in the position of the patient on his stomach. To enhance independent blood flow through the vein and to facilitate obtaining a Doppler study, the patient is offered to lean with the straightened thumbs on the couch. The sensor is installed in the popliteal fossa. A transverse scan is performed to determine the topographic relationships of the vessels. Doppler is recorded and the shape of the curve is evaluated. If the blood flow in the vein is weak, compression of the lower leg is performed, and an increase in blood flow through the vein is revealed. In longitudinal scanning of a vessel, attention is paid to the contour of the walls, the lumen of the vessel, the presence of valves (usually 1-2 valves can be identified).

Doppler sonography of peripheral vessels. Part 1.

N.F. Beresten, A.O. Tsypunov

In modern functional diagnostics, ultrasound techniques are increasingly used to study blood vessels. This is due to its relatively low cost, simplicity, non-invasiveness and safety of the study for the patient with a sufficiently high information content compared to traditional X-ray angiographic techniques. The latest models of Medison ultrasound tomographs allow high-quality examination of blood vessels, successfully diagnose the level and length of occlusive lesions, identify aneurysms, deformities, hypo- and aplasias, shunts, valvular insufficiency veins and other vascular pathology.

To carry out vascular studies, an ultrasound tomograph operating in duplex and triplex modes, a set of sensors (table) and a software package for vascular studies are required.

The studies presented in this material were carried out on a SA-8800 Digital / Gaia ultrasound tomograph (Medison, South Korea) during screening among patients sent for ultrasound examination of other organs.

Vascular ultrasound technology

The sensor is installed in a typical area of \u200b\u200bpassage of the investigated vessel ( fig. 1).

2, 3 - vessels of the neck:

OSA, VSA, NSA, PA, YAV;

4 - subclavian artery;

5 - vessels of the shoulder:

brachial artery and vein;

6 - vessels of the forearm;

7 - vessels of the thigh:

8 - popliteal artery and vein;

9 - posterior b / tibial artery;

10 - dorsal artery of the foot.

МЖ1 - upper third of the thigh;

МЖ2 - lower third of the thigh;

МЖЗ - upper third of the lower leg;

МЖ4 - lower third of the lower leg.

To clarify the topography of the vessels, scanning is performed in a plane perpendicular to the anatomical course of the vessel. With transverse scanning, the interposition of the vessels, their diameter, wall thickness and density, and the state of the perivascular tissues are determined. Using the function and tracing the inner contour of the vessel, the area of \u200b\u200bits effective cross-section is obtained. Next, a transverse scan is performed along the studied segment of the vessel to search for areas of stenosis. When stenosis is detected, a program is used to obtain a calculated stenosis index. Then a longitudinal scanning of the vessel is carried out, evaluating its course, diameter, inner contour and wall density, their elasticity, pulsation activity (using the M-mode), and the state of the vessel lumen. Measure the thickness of the intima-media complex (along the far wall). Doppler examination is carried out in several areas, moving the sensor along the scanning plane and inspecting the largest possible area of \u200b\u200bthe vessel.

The following scheme of Doppler vascular examination is optimal:

• color Doppler mapping based on directional analysis (CDC) or flow energy (CDCE) to search for areas with abnormal blood flow;
• doppler sonography of a vessel in a pulsed mode (D), which allows assessing the speed and direction of flow in the examined blood volume;
• doppler sonography of a vessel in continuous wave mode to study high-speed flows.

If the ultrasound examination is carried out with a linear transducer, and the axis of the vessel runs almost perpendicular to the surface, the Doppler beam tilt function is used to tilt the Doppler front of the awards relative to the surface. Then, using the function, the angle pointer is aligned with the true course of the vessel, a stable spectrum is obtained, the image scale (,) and the position of the zero line (,) are set. It is customary to place the main spectrum above the baseline when examining arteries, and below when examining veins. A number of authors recommend for all vessels, including veins, to have the antegrade spectrum at the top, and the retrograde at the bottom. The function swaps the positive and negative semiaxes on the ordinate (velocity) axis and thus changes the direction of the spectrum on the screen in the opposite direction. The selected time base speed should be sufficient to observe 2-3 complexes on the screen.

Calculation of the velocity characteristics of flows in the pulsed Doppler mode is possible at a flow velocity of no more than 1-1.5 m / s (Nyquist limit). To obtain a more accurate picture of the distribution of velocities, it is necessary to establish a control volume of at least 2/3 of the lumen of the studied vessel. The programs are used in the study of the vessels of the extremities and in the study of the vessels of the neck. Working in the program, the name of the corresponding vessel is noted, the values \u200b\u200bof the maximum systolic and minimum diastolic velocities are recorded, after which one complex is outlined. After all these measurements, you can get a report that includes the values \u200b\u200bof V max, V min, V mean, PI, RI for all examined vessels.

Quantitative Doppler sonographic parameters of arterial blood flow

2 D% stenosis -% STA \u003d (Stenosis Area / Blood Vessel Area) * 100%. It characterizes the real decrease in the area of \u200b\u200bthe hemodynamically effective section of the vessel as a result of stenosis, expressed as a percentage.

V max - maximum systolic (or peak) velocity - real maximum linear blood flow velocity along the vessel axis, expressed in mm / s, cm / s or m / s.

V min is the minimum diastolic linear velocity of blood flow along the vessel.

V mean is the velocity integral under the curve enveloping the blood flow spectrum in the vessel.

RI (Resistivity Index, Purselo index) - vascular resistance index. RI \u003d (V systolic - V diastolic) / V systolic. Reflects the state of resistance to blood flow distal to the measurement site.

PI (Pulsatility Index, Gosling index) - pulsation index, indirectly reflects the state of resistance to blood flow PI \u003d (V systolic - V diastolic) / V mean. It is a more sensitive indicator than RI, since V mean is used in the calculations, which reacts earlier to changes in the lumen and tone of the vessel than V systolic.

It is important to use PI, RI together, because they reflect different properties of blood flow in an artery. Using only one of them without considering the other may cause diagnostic errors.

Qualitative assessment of the Doppler spectrum

There are laminar, turbulent and mixed flow types.

Laminar type is the normal variant of blood flow in the vessels. A sign of laminar blood flow is the presence of a "spectral window" on the Doppler pattern at the optimal angle between the direction of the ultrasound beam and the flow axis (Fig. 2a). If this angle is large enough, then the "spectral window" can "close" even with a laminar type of blood flow.

Figure: 2a Main blood flow.

The turbulent type of blood flow is characteristic for places of stenosis or incomplete occlusions of the vessel and is characterized by the absence of a "spectral window" on the Doppler study. With CDC, mosaic coloring is revealed, due to the movement of particles in different directions.

The mixed type of blood flow can normally be determined in places of physiological vasoconstriction, arterial bifurcations. It is characterized by the presence of small turbulence zones in laminar flow. At CDC, a point mosaicity of the flow is revealed in the area of \u200b\u200bbifurcation or narrowing.

In the peripheral arteries of the extremities, the following types of blood flow are also distinguished based on the analysis of the envelope curve of the Doppler spectrum.

The main type is a normal variant of blood flow in the main arteries of the extremities. It is characterized by the presence of a three-phase curve on the Doppler pattern, consisting of two antegrade and one retrograde peaks. The first peak of the curve is systolic antegrade, high-amplitude, pointed. The second peak is a slight retrograde (blood flow in diastole before the closure of the aortic valve). The third peak is a small antegrade peak (blood reflection from the aortic valve leaflets). It should be noted that the main type of blood flow can persist even with hemodynamically insignificant stenosis of the main arteries. ( Figure: 2a, 4 ).

Figure: 4 Variants of the main type of blood flow in the artery. Longitudinal scanning. CDK. Pulsed Doppler.

The main altered type of blood flow is recorded below the site of stenosis or incomplete occlusion. The first systolic peak is changed, of sufficient amplitude, widened, flatter. The retrograde peak can be very weak. The second antegrade peak is absent ( fig.2b).

Figure: 2b Main altered blood flow.

Collateral type of blood flow is also recorded below the occlusion site. It appears close to a monophasic curve with a significant change in systolic and the absence of retrograde and second antegrade peaks ( fig. 2c) .

Figure: 2c Collateral blood flow.

The difference between Doppler images of the vessels of the head and neck from Doppler images. extremities is that the diastolic phase on Doppler images of the arteries of the brachycephalic system is never below 0 (i.e., does not fall below the Base line). This is due to the peculiarities of the blood supply to the brain. In this case, on the Doppler images of the vessels of the internal carotid artery system, the diastolic phase is higher, and the external carotid artery system is lower ( fig. 3).

Figure: 3 Difference between NSA and ICA Dopplergrams.

a) the envelope of the Dopplerogram obtained with the NSA;

b) the envelope of the Dopplerogram obtained from the ICA.

Study of the vessels of the neck

The sensor is installed alternately on each side of the neck in the area of \u200b\u200bthe sternocleidomastoid muscle in the projection of the common carotid artery. In this case, the common carotid arteries, their bifurcations, internal jugular veins... Evaluate the contour of the arteries, their internal lumen, measure and compare the diameter on both sides at the same level. To distinguish the internal carotid artery (ICA) from the external (ECA), the following features are used:

internal carotid artery has a larger diameter than the outer one;

the initial section of the ICA lies lateral to the ECA;

The ICA on the neck gives branches, it can have a "loose" type of structure, the ICA on the neck has no branches;

on the dopplerogram of the ECA, an acute systolic peak and a low-lying diastolic component are determined (Fig. 3a), on the Doppler study obtained with the ICA, a wide systolic peak and a high diastolic component are determined (Fig. 36). D.Russel test is carried out for control. After obtaining the Doppler spectrum from the localized artery, short-term compression of the superficial temporal artery (immediately in front of the ear tragus) is performed on the side of the study. When locating the ICA, additional peaks will appear on the Dopplergram; when locating the ICA, the shape of the curve will not change.

When examining the vertebral arteries, the sensor is placed at an angle of 90 ° to the horizontal axis, or directly above the transverse processes in the horizontal plane.

Vmax (Vpeak), Vmin (Ved), Vmean (TAV), PI, RI are calculated using the Carotid program. Compare the indicators obtained from opposite sides.

Study of the vessels of the upper extremities

The position of the patient is on the back. The head leans back a little, a small roller is placed under the shoulder blades. The study of the aortic arch and the initial sections of the subclavian arteries is carried out with the suprasternal position of the sensor (see Fig. 1). The aortic arch, the initial sections of the left subclavian artery are visualized. From the supraclavicular access, the subclavian arteries are examined. Comparison of the indicators obtained on the left and right to identify asymmetry. If occlusions or stenoses of the subclavian artery are detected before the vertebral origin (1 segment), a test with reactive hyperemia is performed to detect the “steal” syndrome. For this, the brachial artery is compressed with a pneumatic cuff for 3 minutes. At the end of the compression, the blood flow velocity in the vertebral artery is measured and the air is drastically released from the cuff. Increased blood flow in the vertebral artery indicates a lesion in the subclavian artery and retrograde blood flow in the vertebral artery. If there is no increase in blood flow, the blood flow in the vertebral artery is antegrade and there is no occlusion of the subclavian artery. To study the axillary artery, the arm on the side of the study is retracted outward and rotated. The scanning surface of the sensor is installed in the oblique fossa and tilted downward. Compare indicators from both sides. The study of the brachial artery is carried out with the sensor located in the medial groove of the shoulder (see. fig. one). Systolic blood pressure is measured. The tonometer cuff is applied to the shoulder, the Doppler spectrum is obtained from the brachial artery below the cuff. Blood pressure is measured. The criterion for systolic blood pressure is the appearance of a Doppler spectrum with Doppler. Compare the indicators obtained from opposite sides.

The asymmetry index is calculated: PN \u003d HELL sist. dext. - HELL sist. sin. [mm. rt. Art.]. Normal -20

Study of the femoral arteries. The original position of the transducer is under the inguinal ligament (transverse scan) (see Fig. 1). After assessing the diameter and lumen of the vessel, scanning is performed along the common femoral, superficial femoral and deep femoral arteries. The Doppler spectrum is recorded, the results obtained are compared on both sides.

Study of the popliteal arteries. The position of the patient is lying on his stomach. The sensor is installed in the popliteal fossa across the axis of the lower extremity. Transverse, then longitudinal scanning is performed.

To clarify the nature of the blood flow in the altered vessel, the regional pressure is measured. To do this, put the tonometer cuff first on the upper third of the thigh and measure the systolic blood pressure, then on the lower third of the thigh. The criterion for systolic blood pressure is the appearance of blood flow during Doppler sonography of the popliteal artery. The index of regional pressure at the level of the upper and lower third of the thigh is calculated: RID \u003d BP syst (hip) / BP syst (shoulder), which should normally be greater than 1.

Examination of the leg arteries. In the position of the patient on his stomach, a longitudinal scan is performed from the place of division of the popliteal artery along each of the branches, alternately on both legs. Then, in the position of the patient on the back, the posterior tibial artery in the region of the medial ankle and the dorsal artery of the foot in the region of the dorsum of the foot are scanned. Qualitative location of arteries at these points is not always possible. An additional criterion for assessing blood flow is the regional pressure index (RID). To calculate the RID, the cuff is sequentially applied first to the upper third of the lower leg, the systolic pressure is measured, then the cuff is applied to the lower third of the lower leg and the measurements are repeated. During compression, scan a. tibialis posterior or a. dorsalis pedis. RID \u003d syst (lower leg) BP / system (shoulder) BP, normal\u003e \u003d 1. RID obtained at level 4 of the cuff is called the ankle pressure index (LID).

Study of the veins of the lower extremities. It is carried out simultaneously with the study of the arteries of the same name or as an independent study.

The study of the femoral vein is carried out with the patient in the supine position with legs slightly divorced and rotated outward. The sensor is installed in the groin fold parallel to it. A cross-section of the femoral bundle is obtained, the femoral vein is found, which is located medial to the artery of the same name. The contour of the vein walls, its lumen are assessed, a dopplerogram is recorded. By deploying the sensor, a longitudinal section of the vein is obtained. Scanning is performed along the vein, the contour of the walls, the lumen of the vessel, and the presence of valves are assessed. Doppler is recorded. The shape of the curve and its synchronization with breathing are evaluated. A breathing test is carried out: deep breath, holding the breath with straining for 5 seconds. The function of the valve apparatus is determined: the presence of vein expansion during the test below the level of the valve and retrograde wave. When a retrograde wave is detected, its duration is measured and maximum speed... A study of the deep vein of the thigh is carried out in a similar manner, setting the control volume for the valve of the vein during Doppler ultrasonography.

The study of the popliteal veins is carried out in the position of the patient on his stomach. To enhance independent blood flow through the vein and to facilitate obtaining a Doppler study, the patient is offered to lean with the straightened thumbs on the couch. The sensor is installed in the popliteal fossa area. A transverse scan is performed to determine the topographic relationships of the vessels. Doppler is recorded and the shape of the curve is evaluated. If the blood flow in the vein is weak, compression of the lower leg is performed, and an increase in blood flow through the vein is revealed. When longitudinal scanning of a vessel, attention is paid to the contour of the walls, the lumen of the vessel, the presence of valves (usually 1-2 valves can be identified) ( fig. five).

Figure: 5 Study of blood flow in a vein using CDC and pulsed Doppler.

A proximal compression test is performed to detect the retrograde wave. After obtaining a stable spectrum, the lower third of the thigh is squeezed for 5 seconds to detect retrograde current. The study of the saphenous veins is carried out with a high-frequency (7.5-10.0 MHz) transducer according to the above-described scheme, having previously installed the transducer in the projection of these veins. It is important to scan through the "gel pad", holding the transducer over the skin, as even slight pressure on these veins is sufficient to reduce blood flow in them.

Pressure pills: which are the best? Let's discuss and understand with you. This article was written because thousands of people are searching the Internet for an answer to the question: which best pills from high blood pressure? Few people want to spend the time and money to find and visit a good doctor who can individually select a medicine for hypertension. We strongly recommend taking tests and consulting a doctor. But still, we hasten to please you: the best pressure pills exist! First, we will try to provide answers to the questions about medicines that are most often asked by patients with hypertension. These questions are collected from medical practice and on forums on the Internet. After that, you will learn about very effective and most importantly harmless drugs for pressure, which are sold in the pharmacy.

The cause of hypertension is not a lack of pills in the body, but metabolic disorders. Medicines prescribed by doctors usually only muffle the symptoms, but do not eliminate the causes of high blood pressure. Over time, metabolic disorders increase so much that drugs stop helping. If treated correctly, hypertension can be kept under control without "hungry" diets and hard physical exertion, using a minimum of drugs. Study this article and do what it says. Continue taking your medications at the same time. When the recommendations give a result, try to reduce the dosage of the drugs.

You may be developing heart failure. It's deadly dangerous disease, which is often caused by hypertension if it is not treated or treated poorly. Read here how to properly treat yourself. To achieve good results in the treatment of heart failure, you need to combine the formal and alternative medicine... Neither one nor the other should be neglected. Take heart failure control as seriously as possible.

Perhaps you have hypertension combined with diabetes mellitus... Test your blood for sugar. It is better to be tested for glycated hemoglobin, rather than blood sugar on an empty stomach. If diabetes is confirmed, then read here how to properly treat it. You will need a stricter regimen than people with non-diabetic hypertension. But on the other hand, the results of treatment will be the envy of their peers.

This is called a hypertensive crisis. Another such attack can cause a heart attack or stroke. To prevent them, study this material and follow the recommendations. Also figure out how to render emergency care with hypertensive crisis. Keep in your home medicine cabinet the medications recommended in the article. It also says which popular hypertensive crisis pills are actually harmful. Throw them away if you find them in your home.

You need to lower the dosage or cancel some of the drugs. It is advisable to do this under the supervision of a physician. You cannot give a general recommendation here, you need to know in detail your individual nuances. Ask a question in the comments to one of the articles on this site. Indicate your age, height, weight, what medications you are taking, test and examination results, and other important information.

Indapamide, bisoprolol and diroton are a good set. If there are no individual side effectsthen you can continue. Discuss dosages with your doctor. Menopause hypertension usually responds well to the treatment described here. Please note that you do not need to starve yourself, the recommended food is tasty and satisfying. Usually, hypertension in women during menopause is combined with overweight. It is easy to take control of it using the methodology promoted by this site. Let's remind that for women the normal weight is “height minus 110” kg. If your body weight does not exceed the norm indicated above, then this is an unusual situation. In this case, you need to seriously understand the reasons for your high blood pressure. For more details, read "Causes of Hypertension and How to Eliminate Them."

If the attacks recur, then study the article "Endocrine causes of hypertension" and examine, as it says.

Increased blood pressure at dawn and in the morning is a menacing sign. Your risk of heart attack is much higher than that of people whose blood pressure rises in the afternoon or late afternoon. Study the article "Causes of Hypertension and How to Eliminate Them", and then take tests and go through examinations. Check your kidneys especially. It is advisable to monitor your blood pressure 24 hours a day to determine the appropriate hours for medication. We need an intelligent doctor who will deal with you. The first doctor you come across is unlikely to help.

In the case of unexplained jumps in blood pressure back and forth from low to high, thyrotoxicosis can be suspected - elevated level thyroid hormones in the blood. Study the article "Endocrine causes of hypertension" and examine, as it says. If you really have thyroid problems, then you need to learn English and read the book “Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal”. It describes methods of effective treatment. What domestic doctors will offer you will not help much. Unfortunately, it is problematic to find this information in Russian.

Find the combination of drugs and their optimal dosage under the guidance of your doctor. Also read this article and follow the recommendations outlined in it. Learn how to keep hypertension under control with minimal or no medication. The unpleasant symptoms you experience during a change of weather will greatly diminish. Strive to blood pressure was stable close to 120/80, or even about 110-115 / 85-90. This can be achieved if you follow the recommendations on our website. At the same time, you can lead a normal life without too restricting yourself.

How dangerous is all this? It depends on how long you want to live. You have a serious risk of not making it to retirement. If such a danger does not bother you - continue to lead the same lifestyle as before. How to be treated? Study this article and do what it says. Within a few days, you will feel that your well-being is improving, and over time, the results of repeated blood tests will also please. This technique normalizes not only blood pressure, but also cholesterol and blood sugar. Ironically, eating fatty meats improves the ratio of “bad” to “good” cholesterol. The main thing is a strict rejection of prohibited foods overloaded with carbohydrates.

Noliprel, amlodipine, concor is one of the most powerful drug combinations for hypertension. Noliprel contains two active ingredientsa, and amlodipine and concor - one at a time. Together, four active substances are obtained that lower blood pressure in different ways at the same time. Noliprel and amlodipine together in many patients cause hypotension, and if you add concor or another beta-blocker to them, this risk increases significantly. Not only blood pressure, but also the pulse may drop excessively. Do not use the medicines listed above for self-medication like any other pressure pills. Consult your doctor!

The metabolic disorder that caused the hypertension has become too severe in your husband. When this happens, even the most powerful drugs can no longer keep blood pressure under control. What to do? The methods described in the articles "How to lower blood pressure quickly" and "Causes of hypertension: how to eliminate them" will help. Following the recommendations, the patient should continue to take the pills prescribed by the doctor. After a few days, it will become noticeable that the technique is giving a result. After that, it is possible and necessary to reduce the dosage of drugs so that there is no hypotension. It is advisable to do this under the supervision of a doctor.

Medicines for hypertension are prescribed by a doctor. This cannot be done “in absentia” via the Internet. You should study this article and then diligently do what it says. For the first time, continue to take your doctor's prescribed pills. Once the alternative treatment is successful, you can gradually reduce the dosage of the medication. It will even be necessary to do this so that the pressure does not drop below normal. If you have not yet had time to develop kidney problems, then you will quickly take control of your hypertension. Blood pressure will return to normal, even if you cannot lose weight significantly. It turns out that you can keep it stable normal pressure and at the same time do not suffer from hunger.

The next hypertensive crisis can result in a heart attack or stroke. These are irreversible catastrophic complications. The medications that you take every day significantly reduce the likelihood of developing a hypertensive crisis, reduce the risk of heart attack and stroke. Therefore, you should not completely abandon them. However, if the pills lower the pressure to 100/50 and make you feel worse, then you need to lower the dosage. It may be best to keep 1-2 of the three pills you are prescribed. Only a competent doctor can give specific recommendations, not the Internet. Check out articles on diuretics and beta blockers. Understand which drugs are considered good and which are outdated. If you have been prescribed outdated pills, then, in consultation with your doctor, refuse them. Or replace with modern drugsthat act smoothly.

For a 29-year-old person, the pressure of 149/82 is not normal, but a lot. Notice how many men between the ages of 40-50 die from heart attacks or strokes. If you do not want to be among them, then study the article "The causes of hypertension and how to eliminate them." Examine, as it says there, to establish your cause and pick up recommendations for treatment.

Indeed, Arifon retard is a diuretic (diuretic) indapamide. It is good because:

• Has minimal side effects, it is one of the safest diuretic drugs for hypertension
• Virtually no effect on the level of glucose and fats in the blood, that is, it is harmless for diabetics and people with obesity
• You can take it only once a day, usually it is recommended to do it in the morning.

You better follow not the "diuretic effect", but the indicators of your blood pressure. You need to have a tonometer at home and use it 1-2 times a day. Only by how you feel, without a tonometer, you will not be able to determine where your pressure is going. If, under the influence of Arifon tablets, it decreases, everything is OK. If after a month there are no changes, the dose should not be increased anyway. See your doctor to have her change or add another medicine to Arifone.

Your information is half out of date. Previously, aspirin tablets for prophylaxis were prescribed to almost everyone in a row. And now - only to patients who have already suffered a heart attack, ischemic stroke, heart surgery or are worried about attacks of angina pectoris - pain in the heart. Aspirin does help in the prevention of recurrent cardiovascular "events." But if a person does not have cardiovascular disease, then taking aspirin daily will do more harm than good. Because acetylsalicylic acid damages the stomach lining. This can cause dangerous gastrointestinal bleeding. Even people who take low doses of aspirin are not immune from side effects.

If your blood pressure is above 160/100 mm Hg. Art., despite the reception antihypertensive drugs, then adding aspirin will increase the risk of hemorrhagic stroke, which is even more dangerous than ischemic stroke. First of all, you need to choose a combination of drugs for hypertension that can take your blood pressure under control - lower it to 140/90 or lower. Almost all patients manage to bring their blood pressure back to normal by switching to healthy image life and, if necessary, take well-chosen medicines. As a last resort, you can discuss with your doctor whether you should take aspirin daily for prevention. If you start taking it, then under the pretext of this, do not try to reduce your dosage of pressure pills or refuse them.

You are doing the right thing to worry about your situation. Skipping your medication for high blood pressure can suddenly lead to trouble. A sharp jump in pressure can be the cause from a headache to the most tragic consequences. This should not be allowed. Moreover, it is not difficult to find the most suitable medicine for you.

Kapoten is the same as captopril. It belongs to a class of drugs for high blood pressure and heart disease called ACE inhibitors. If it helps you well, then changing it to a drug from a different class would not be advisable. In fact, capoten (captopril) was the first ACE inhibitor developed. Newer drugs in this group last longer, so they can be taken less often, 1 or 2 times a day.

Don't change your hypertension pills yourself! See your doctor! From the materials on our website, you can find out everything you need to know about ACE inhibitors, and then pay a visit to the doctor in order to choose a medicine for yourself with him. To reduce the risk hypertensive crises, in the "transition" period, take care of yourself while the body adapts.

Enap (enalapril) refers to ACE inhibitors, just like the capoten (captopril) we just discussed. The most common side effect of drugs in this group is a dry cough. About 20% of patients complain about it. If enalapril helps you with pressure well, but causes a cough, then you need to switch to another drug, which will belong to the class of angiotensin II receptor blockers. They are also called "sartans": losartan (Kozaar, Lozap), candesartan, telmisartan (Mikardis), valsartan (Diovan), irbesartan (Aprovel), eprosartan (Teveten) and others.

Sartans help no worse than ACE inhibitors, but they practically do not cause side effects. Unfortunately, they are more expensive than all other drugs for hypertension. As for the “procedure” for replacing the drug, then all the same warnings are addressed to you as the author of the previous question. Consult a competent doctor! The doctor, who has extensive practice and at the same time hundreds of patients under supervision, knows exactly which of the angiotensin II receptor blockers works more effectively than others

Whether this is too much depends on your current blood pressure indicators and associated diseases. Diabetes? Problems with heart? How high is your risk of sudden stroke or heart attack? The doctor takes all this into account when writing prescriptions. You probably went to the doctor already at an advanced stage of hypertension.

You will learn a lot of important information for yourself in the following articles:

• Treatment of hypertension with combination drugs
• How to choose a medicine for hypertension - general principles
• What to do if medication doesn't help lower blood pressure

The use of clonidine as the "main" medicine for blood pressure does cause significant harm, here your doctor is 100% right. Moreover, he good doctorbecause he didn't give up on you. Clonidine (clonidine) lowers blood pressure quickly and strongly, but it does not last long, a matter of hours. As a result, the patient's blood pressure indicators become similar to a "roller coaster", that is, they have a significant amplitude of fluctuations several times a day. It is very harmful to blood vessels and shortens life span. Clonidine “therapy” increases the likelihood of heart attack or stroke.

More modern medicines normalize blood pressure for a long time and act softer, so it is much safer to take them. By the way, clonidine, among other things, acts on the brain and therefore is addictive like a drug. In general, if your mother wants to live longer, then let her “jump” off clonidine and start taking another medicine, which the doctor prescribed.

Noliprel is a combination medicine for hypertension, one of the most powerful. Doctors love to prescribe it to an overweight patient like yours. However, its effectiveness diminishes over time as the disease progresses. The condition of your blood vessels deteriorates, and the resistance to blood flow increases. Because of this, the pressure rises and the medicine can no longer keep it normal. Noliprel has 5 varieties, with different dosages active ingredients in one tablet. In theory, you can see a doctor who will switch you to a more powerful option. The most potent is Noliprel Bi-Forte. Read a detailed article about Noliprel.

Switching to more powerful pills will only give you a delay of 2-3 years. This development of events usually ends with a heart attack or stroke. What to do? Treat the cause of hypertension. Fortunately, in your case it is not difficult. Overweight + high blood pressure is called metabolic syndrome. You need to read this article and do what it says. Pre-pass blood and urine tests, a list of which is given here. After 3 weeks or less, you will feel much better. Middle age, so it is unlikely that hypertension has already caused irreversible consequences... When the pressure starts to drop, try switching to a weaker version of Noliprel, and then completely abandon the "chemical" tablets.

Probably your cardiologist recently visited medical representative - an employee of the company that produces Bisogamma. And his visit was successful :). The original bisoprolol is called Concor, it is produced in Germany. It has many cheaper analogs that are produced by other pharmaceutical factories. These analogues include Bisoprolol-Prana and Bisogamma. In theory, they should all act no worse than Concor. But in practice they have different efficiency and portability. All this is individual. What works for some patients will cause serious side effects in others. Read the detailed article “Bisoprolol Concor and its analogues”.

Hypothiazide is the same as hydrochlorothiazide (dichlothiazide). It is a "classic" diuretic drug for the treatment of hypertension, cheap and very effective. Indeed, under the influence of these tablets, more potassium is excreted from the body than usual. But small doses of the drug are prescribed to normalize high blood pressure, so you should not worry.

Taking potassium tablets (such as asparkam or panangin) is usually not necessary. Only sound the alarm if you feel very weak. But even then, additional intake of potassium can only be carried out under the supervision of a doctor. Your doctor may also prescribe another potassium-sparing diuretic drug for you. Do not take any additional medications on your own initiative! You can include potassium-rich foods in your diet. These are fruits, vegetables and nuts.

You will be interested in the following facts:

• Hypothiazide is the drug of choice for the treatment of hypertension in elderly patients who do not have concomitant diabetes or obesity;
• This medicine increases the excretion of potassium from the body, but reduces the loss of calcium;
• There is evidence that it is a means of preventing osteoporosis, that is, in older patients, the frequency of bone fractures is reduced.

Read also the articles:

• Potassium-rich diet for hypertension
• Dichlothiazide (hypothiazide)
• Side effects of thiazide diuretics

The best drugs for pressure - what are they?

Ideally, a medicine for hypertension should have the following remarkable properties:

• Helps at least 70-80% of patients with high blood pressure;
• In addition to treating hypertension, it has the following actions on the body: improves sleep, relieves PMS in women, makes a person calmer, protects the heart and kidneys;
• Has no harmful side effects;
• Most likely, you can buy it at your nearest pharmacy - no need to contact the sellers of questionable dietary supplements;
• It has no contraindications, except for severe renal failure.

Is there really such a "magic" medicine? Yes, and that's magnesium! Magnesium deficiency in the body is one of the most frequent reasons development of hypertension. Accordingly, the elimination of this deficit helps to quickly normalize blood pressure.

Proven effective and cost-effective blood pressure supplements:

• Source Naturals Magnesium + Vitamin B6
• Taurine by Jarrow Formulas
• Fish Oil from Now Foods.

How to order hypertension supplements from the USA - download instructions. Bring your blood pressure back to normal without the harmful side effects that chemical pills cause. Improve heart function. Become calmer, relieve anxiety, sleep like a child at night. Magnesium with vitamin B6 works wonders for hypertension and other health problems. You will have excellent health, to the envy of your peers.

• Magnesium + Vitamin B6
• Taurine is a natural substitute for harmful diuretic drugs
• Fish fat

For more information on the safe and effective treatment of hypertension, read the notes linked below. Start with the article “ Effective treatment hypertension without drugs ”- this is the main material on our website. It is convenient to save a picture with a picture of high-quality magnesium preparations in order to print it on a printer and take it with you to the pharmacy.

• The best way to recover from hypertension (fast, easy, healthy, no "chemical" drugs and dietary supplements)
• Hypertonic disease - folk way recover from it at stages 1 and 2
• The causes of hypertension and how to eliminate them. Analyzes for hypertension

Pharmacological tablets for pressure

As for “chemical” pressure tablets, there are no universal options. They all have harmful side effects, unlike magnesium. If taken, then only as directed by a doctor! The doctor will prescribe a medication for you individually, taking into account your concomitant diseases. For example, diabetics are prescribed some drugs for hypertension, for kidney problems - others, with concomitant angina - the third, with arrhythmia - the fourth, etc. The article "Medicines for hypertension: what they are" tells about this in detail.

What is the best way for you to proceed? How to start treating hypertension? What medications to take to lower blood pressure? It depends on how much you risk getting a sudden heart attack or stroke. If your blood pressure exceeds 160/100 mm. rt. Art. - consult a doctor immediately! If your blood pressure is now from 140/90 to 159/99, but you already have heart or kidney problems - the same thing. And if the risk is small (blood pressure is not higher than 159/99 and there are no concomitant diseases), you will most likely be able to take hypertension under control according to the method described in the article "Treatment of hypertension without drugs."

Regular medical examinations for hypertension

Even if you do not want to take "chemical" drugs for pressure, anyway, every person with hypertension should consult a doctor and take the tests that we recommend. Check the work of your heart and kidneys ... well, and your liver at the same time :). Find out your blood cholesterol level. With just one “comprehensive” blood test, you can reliably assess the risks of heart attack, stroke and diabetes. If you want to live longer, then a medical examination should be done regularly every six months. You should not be afraid to find out the bitter truth after the tests. If you decide to normalize blood cholesterol and risk factors for cardiovascular disease, then this can be done quickly and easily.

After reading today's material, you are convinced that "the health and longevity of hypertensive patients is the work of hypertensive patients themselves." Most effective pills from pressure - these are not only traditional "chemical" preparations, but also natural minerals and vitamins. The method of treating hypertension using magnesium, fish oil, B vitamins and other natural substances has already helped tens of hundreds of patients in our country. Now it's your turn!

• What medicines for hypertension are prescribed for elderly patients?
• The DASH diet: an effective diet for hypertension
• Garlic - folk remedy from hypertension

From this article you will learn how the ultrasound scan of the vessels of the lower extremities is performed, who is prescribed the procedure. What can be diagnosed using the ultrasound scan.

Date of publication of the article: 11.06.2017

Date the article was updated: 05/29/2019

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

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

Different doctors can refer you to this examination: therapist, phlebologist, angiologist. The procedure is performed by an ultrasound specialist.

Indications

Doppler ultrasonography of the vessels of the legs is prescribed for the diagnosis of such diseases:

1. Phlebeurysm.
2. Thrombophlebitis.
3. Atherosclerosis.
4. Thrombosis.
5. Spasm of the arteries of the legs (angiospasm).
6. Arterial aneurysms (dilatations).
7. Obliterating endarteritis (an inflammatory disease of the arteries that causes them to narrow).
8. Arteriovenous malformations (abnormal connections between arteries and veins).

What are the symptoms of prescribing USDG

Patients are referred for this diagnostic procedure if vascular diseases of the legs are suspected. Your doctor may prescribe an ultrasound scan for you if you experience any of the following symptoms:

• swelling of the legs;
• heaviness in the legs;
• frequent paleness, redness, blue legs;
• "Chills", numbness in the legs;
• pain when walking less than 1000 meters;
• cramps in the calf muscles;
• vascular "asterisks", "nets", protruding veins;
• a tendency to freezing 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 is prophylactic Doppler sonography needed?

Doppler ultrasonography of the leg vessels for prophylactic purposes once every six months or a year if you are at risk. Vascular diseases of the lower extremities are prone to:

• overweight people;
• those engaged in 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 mellitus;
• smokers;
• people over 45;
• women during pregnancy and menopause;
• women who have been taking oral contraceptives for a long time.

Training

The procedure does not require any complicated preparation.

The only thing is that your feet must be clean. If, due to your individual characteristics, you have thick hair on your legs, it is advisable to shave it off so that the doctor can work easier.

On the day of the procedure, do not drink alcohol, stimulating drinks (coffee, strong tea, energy drinks), do not expose your feet physical activity (don't run, don't lift weights, don't go to training). 2 hours before the ultrasound scan of the vessels of the lower extremities (and other vessels too) do not smoke. Better to go to the examination in the morning.

Take napkins or a towel with you to the procedure so that you can dry your feet later. Also bring your doctor's referral for an ultrasound scan and the results of previous vascular examinations.

How the research is done

First, you free your legs from clothes.

The examination will be done while standing or lying down. The doctor applies the ultrasound gel and guides the ultrasound probe over the legs.

The image of your vessels is displayed on the monitor of a specialist. Immediately during the procedure, it analyzes and records the data obtained.

If you will be examined while lying down, the doctor will first tell you to lie on your stomach and raise your legs on your toes. Alternatively, you can place 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 posterior 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 anterior surface of the legs.

Leg vein anatomy. Click on the photo to enlarge

During the ultrasound scan, to detect refluxes (reverse blood discharge), the doctor may perform special tests:

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

Doppler sonography of the vessels takes about 10-15 minutes in total.

At the end of the examination, you wipe your feet from the remains of the ultrasound gel, get dressed, take the result and you can go.

What does the USDG show of the vessels of the legs

With the help of Doppler ultrasonography of the lower extremities, the following vessels of the legs can be examined:

During this diagnostic procedure, the doctor may see:

• the shape and location of the vessels;
• diameter of the vessel lumen;
• the condition of the vascular walls;
• condition of arterial and venous valves;
• the speed of blood flow in the legs;
• the presence of reflux (reverse shunt of blood, which is often found with varicose 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).

UZDG standards, conclusion with explanations

Veins should be passable, not dilated, walls not thickened. The lumens of the arteries are not narrowed.

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

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

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

Abnormal connections between vessels are normally absent.

An example of a normal conclusion of USDG veins of the legs and explanations to it

Conclusion: all veins on both sides are passable, compressive, the walls are not thickened, the blood flow is phasic. No intraluminal structures have been identified. The valves are consistent at all levels. There are no pathological refluxes when performing compression tests and Valsalva's 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 patent - means that blood can flow unhindered 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.
Phase blood flow.	Phase blood flow - faster on exhalation and slower on inhalation. This is how it should be normal.
No intraluminal structures have been identified.	Intraluminal structures were not identified - there are no atherosclerotic plaques, blood clots and other inclusions that should not be there.
The valves are consistent at all levels.	The valves are consistent - that is, they perform their functions normally and do not allow back flow of blood.
There are no pathological refluxes when performing compression tests and Valsalva's tests.	There are no pathological refluxes during the tests - the blood is not discharged in the opposite direction under any circumstances, which indicates a healthy blood circulation.

Contraindications

Doppler ultrasonography of the vessels of the lower extremities is an absolutely safe procedure. She has no contraindications and age restrictions.

It can be done with any frequency and by any person, including:

• children of any age;
• elderly;
• people with chronic diseases;
• patients with acute inflammatory diseases;
• those who have a pacemaker implanted (they can direct the ultrasound sensor to their legs, but ultrasound of the chest cavity organs cannot be done);
• pregnant and lactating women;
• for 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 limitation that can be tolerated is an allergy to the ultrasound gel. It occurs in isolated cases. And it is not an absolute contraindication to diagnostics. Allergic reaction can be avoided by choosing a hypoallergenic gel that is right for you.

Gel for ultrasound

Summary, advantages of the procedure

Doppler ultrasonography of the vessels of the lower extremities is an absolutely painless diagnostic method. It does not cause any side effects and has no contraindications (with the exception of allergy to the ultrasound gel). As research by scientists show, ultrasonic waves do not harm the body, therefore, ultrasound of the vessels of the legs can be performed at any frequency.

Unlike MRI, USDG has no restrictions on patient weight and can be performed on people with a pacemaker installed.

This procedure can be performed on patients who are allergic to contrast agents and other iodine-containing drugs, which cannot be said about angiography and contrast phlebography.

Among the advantages can be noted and the low cost. Doppler ultrasonography is significantly cheaper than MRI, angiography and phlebography.

The speed of execution also belongs to the indisputable advantages of the method. UZDG is done in a maximum of 15 minutes. For an MRI, for example, it takes at least half an hour.

We can say that Doppler ultrasonography is the most optimal method for examining blood vessels from those existing today. It combines high accuracy, affordable cost, high speed and almost complete absence of contraindications.

Duplex scanning of the veins of the lower extremities is a type of modern diagnostics of the condition of the venous vessels, which combines two methods - standard and Doppler studies.

This examination is considered the most informative for the diagnosis of a huge number of venous pathologies.

It does not require training and can be performed, due to its safety, in humans different ages and the severity of the condition, including in pregnant women.

Let's take a closer look at this type of ultrasound examination.

The difference between duplex scanning and Doppler

Both of these research methods are based on the Doppler effect, both are equally safe and non-invasive, and they do not feel different for the patient. But they have a cardinal difference:

UZDG	Duplex exploration
The sensor is placed at the points where the veins are projected in most people. Basically, it happens blindly	In the background of the monitor, the tissues along which the vein runs are displayed (as in a conventional ultrasound), that is, the doctor sees where to put the sensor
It is a screening study in vein pathology, that is, it allows you to select only a risk group for thrombosis or varicose veins vessels	Allows you to identify the cause of vein obstruction
Renders only valves that are in standard locations or were found by "blind" search	Capable of providing information on all venous valves
"Sees" veins-perforators, which connect the deep and superficial systems of venous collectors, only in their typical location	Determines the state of perforating veins at any location
Determines that vessel patency is impaired	Identifies the cause of the violation of the patency of the vein, especially if its lumen was narrowed due to compression from the outside
	Determines the source of recurrence of thrombosis or varicose veins after treatment
	Determines the stage of vein thrombosis
	Allows to assess the state of "diseased" veins in dynamics

The study reveals pathologies

The study helps in making such diagnoses:

1. thrombosis of the superficial or deep venous network, its degree, the nature of the thrombus
2. post-thrombophlebitic syndrome
3. valve failure in venous collectors, both superficial and deep
4. chronic venous insufficiency
5. varicose veins
6. fistulas (fistulas) between the vessels
7. traumatic venous injury
8. anomalies in the development of veins
9. assessment of the effectiveness of conservative therapy, invasive or surgical methods of treatment.

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Doppler ultrasound (USG) only determines the patency of the veins, the consistency of those valves that are typically located and that could be detected.

Who needs to undergo this diagnosis

An ultrasound scan of the veins of the lower extremities is necessary once a year for people from the risk category. These are representatives of such professions:

• hairdressers
• sellers
• cooks
• waiters
• secretaries
• office workers
• movers.

Routine ultrasound examination should also undergo:

• overweight people
• pregnant women who had venous pathologies before conception (especially if they are planning a cesarean section)
• women taking contraceptives
• those categories for which work is associated with prolonged standing or sitting
• if there were vascular diseases in the family.

Doppler ultrasound is indicated in case of such complaints:

1. tired legs
2. numbness
3. swelling, especially in the evening
4. discoloration of the feet
5. heaviness in the legs
6. pain in the lower extremities
7. long-term non-healing wounds on the legs.

How to properly prepare for the study

Both duplex scanning and vessel bridging of the lower extremities are done without prior preparation. It is recommended to carry out hygiene measures before the procedure.

How is duplex scanning done

1. The patient comes to the office, undresses from the waist down, leaving only his underwear on.
2. He needs to lie on his back, during the study he will need to take an upright position, and shift onto his stomach.
3. Plaster casts or bandages are removed prior to the procedure.
4. A special acoustic gel is applied to the legs.

To study the deep main veins - the iliac, inferior vena cava, femoral and leg veins, as well as large superficial veins - you will need to lie on your back.

The popliteal veins and vessels of the upper third of the lower leg are examined with the patient in the prone position (does not apply to pregnant women). During the study, the doctor conducts tests in order to determine the condition of the valves and the permeability of the vessel.

To study these vessels (as with ultrasound of the vessels of the head and neck), three scanning modes are used:

1. B-mode (two-dimensional): helps to assess the diameter of the vein, the elasticity of the walls, the nature of its lumen, the presence of valves
2. spectral Doppler mode helps to assess the state of blood flow by phases
3. the color mode helps to assess the characteristics of the lumen of the vessel, the presence of pathological eddies and flows.

How to decrypt data

The norm for a venous vessel is as follows:

• anechoic lumen
• walls - elastic, smooth, thin (up to 2 mm)
• there are valve cusps in the lumen
• the diameter of the deep vein is greater than the diameter of the artery of the same name, but should not exceed the diameter of the artery by 2 times
• in color mode, the vein is completely stained (no gray areas)
• with color mapping, spontaneous blood flow is visible in all veins (if absent in small veins, it is normal)
• spectral analysis shows that the blood flow is synchronized with the respiratory movements of the chest.

Deciphering the signs of venous thrombosis:

• wall thicker than 4 mm
• change in the diameter of the lumen of a vein blocked by a thrombus
• the diameter of the lumen does not change when the vein is squeezed by the sensor
• the lumen does not change during breathing and a straining test
• thrombus visible in B-mode
• valve flaps increased echogenicity, not completely adjacent to the wall, inactive
• no phasic blood flow during breathing
• there is reflux on color examination during the Valsalva test.