The method for determining the blood flow in the v3 segment of the vertebral artery

 

The invention relates to medicine, in particular to angiology. The method allows to provide an objective visual assessment of blood flow and to determine the exact localization of its violation. Conduct ultrasonic duplex scanning with the energy mapping of blood flow, while ultrasonic duplex scanning with the energy mapping of blood flow in the V3 segment of the vertebral artery is carried out lying on his stomach with the support on the forehead, and the ultrasonic transducer is placed between the rear surface of the sternocleidomastoid muscle and the spinous processes of the first cervical vertebra so that the scanning plane is parallel with the bottom edge of the occipital bone, and then, turning the sensor clockwise, position it between the bottom edge of the mastoid process of the occipital bone and the transverse process of the second cervical vertebra thus, to the scanning plane is perpendicular to the bottom edge of the occipital bone. 6 silt.

The invention relates to medicine, namely to angiology, and can be used to assess kovoor what about the entrance artery in a large foramen in the pathology craniovertebral the field of various origins, leading to the violation of arterial blood flow.

A method of obtaining direct images of all the vertebrobasilar system, including the vertebral artery during angiography. To obtain angiographic images using catheterization surgical technique introduction of a contrast agent in the vertebrobasilar system in patients with cerebrovascular disease. To obtain angiographic information about vertebral arteries carry out the insertion of a catheter into the vertebral artery or located near its mouth area subclavian artery from the femoral or brachial artery.

There are a number of contraindications to angiography, for example in a coma, at very high or very low systemic arterial pressure, fresh myocardial infarction and heart failure [Vereshchagin N. In. Pathology of the vertebral-basilar system and the cerebral circulation. M.: Medicine, 1980. - S. 254-258].

However, the way angiography has the following disadvantages:

- invasiveness of the method, since the introduction of the contrast agent in the artery using catheterization surgical technique, including puncture the skin and into the lumen of the artery, as well as holding the catheter in the blood stream to the injection of a contrast agent;

- drug manipulation as a necessary condition for this method is the injection of a contrast agent directly into the arterial blood vessel of the patient. This contrast agent can cause unwanted complications associated with local drug action-contrast the bloodstream, the overall effect of the drug-contrast on the body of the patient;

beam load, because angiography is accompanied by the production of x-ray images. The patient is exposed to x-ray irradiation;

- increase the value of research, as using angiography is attracting supplies (x-ray film, chemicals processing);

- the presence of a large number of contraindications to angiography. In addition to these the author contraindications possible to mark individual intolerance of contrast agents (primarily of preparations containing iodine).

The closest to the achieved result (prototype) is a method of determining blood flow in V3 the blood flow in the V3 segment of the vertebral artery is carried out in the position of the subject lying on his back, thus the ultrasonic sensor installed on the rear edge of the sternocleidomastoid muscle 2-3 cm below the mastoid process with the direction of its axis to the opposite orbit (Y. M. Nikitin, A. I. Trukhanov Ultrasonic Doppler diagnosis of vascular diseases. PM: Vidar, 1998. S. 71-72).

However, the method for determining the blood flow in the V3 segment of the vertebral artery, selected as a prototype, has the following disadvantages:

- the lack of objective visual assessment of the V3 segment of the vertebral artery as Doppler ultrasound allows to obtain only a graphic record of the Doppler curve of the frequency shift of blood;

- no possibility of establishing the exact location of blood flow in any area V3 segment of the vertebral artery as using Doppler ultrasound is obtaining Doppler curve of the frequency shift of blood flow, which can characterize the blood flow not only in the vertebral artery, but in another blood vessel, located in the scan area;

- the inability to obtain data on the state of blood flow in the most remote part of the V3 segment pozvonochnyh the AK as the position sensor, used in the implementation of a method for evaluating blood flow in the V3 segment of the vertebral artery, allowing you to record the blood flow at a lower level segment of the artery (between the transverse processes of the first and second cervical vertebrae).

The invention consists in that the ultrasound power Doppler imaging of blood flow in the V3 segment of the vertebral artery is carried out lying on his stomach with the support on the forehead, and the ultrasonic transducer is placed between the rear surface of the sternocleidomastoid muscle and the spinous processes of the first cervical vertebra so that the scanning plane is parallel with the bottom edge of the occipital bone. Then the sensor is turned clockwise and set between the lower edge of the mastoid process of the occipital bone and the transverse process of the second cervical vertebra so that the scanning plane is perpendicular to the bottom edge of the occipital bone.

The technical result is an objective visual detection of blood flow in the V3 segment of the vertebral artery, the exact localization of violation of arterial blood flow, enhancing qualities of the processes at the level of the V3 segment of the vertebral artery.

The objective for the visual detection of blood flow in the V3 segment of the vertebral artery is done through the analysis of information obtained by means of the ultrasonic sensor, which is displayed on the monitor of the ultrasonic scanner in the form of strips, painted in yellow, one of which is shaped like the letter "U" and another strip with a bend at an obtuse angle. Colored band in the form of the letter "U" represents the image of the blood vessel, namely V3 segment of the vertebral artery in the most remote (distal) part (between the great occipital foramen and the transverse process of the first cervical vertebra) in a two-dimensional image and real-time. Painted strip with a bend at an obtuse angle is an image of a blood vessel, namely V3 segment of the vertebral artery in the initial (proximal) part (between the transverse processes of the first and second cervical vertebrae) in a two-dimensional image and real-time. The intensity of this color allows you to judge the speed of blood flow (the more intense staining, the speed of blood flow in the test vessel above).

Establishing accurate localization violations of arterial blood is tion of the vessel, its shape and relationship with surrounding tissues and blood vessels. Violation of arterial blood flow in the V3 segment of the vertebral artery is characterized by a change in the shape of the artery and the intensity of staining of the bands on the monitor of the ultrasonic scanner.

Improving the quality of research provided the ability to determine blood flow in the V3 segment of the vertebral artery.

The ability to control outcomes and the development of pathological processes carried out by conducting multiple definitions of blood flow in the V3 segment of the vertebral artery.

The invention is illustrated by drawings, where Fig.1 shows a General scheme for determining the blood flow in the distal part of the V3 segment of the vertebral artery at the level between the transverse process of the first cervical vertebra and the great occipital foramen, which implements the method for determining the blood flow in the distal part of the V3 segment of the vertebral artery at the level between the transverse process of the first cervical vertebra and the great occipital foramen; Fig.2 shows a General scheme for determining the blood flow in the proximal part of the V3 segment of the vertebral artery at the level between the transverse processes of the first and second above the AI between the transverse processes of the first and second cervical vertebrae; in Fig.3 is a diagram of the anatomy of the distal part of the V3 segment of the vertebral artery; Fig.4 is a diagram of the anatomy of the proximal part of the V3 segment of the vertebral artery; Fig.5 - image of the right-V3 segment of the vertebral artery in the mode, power Doppler mapping of blood obtained from a healthy patient; Fig.6 - image of the right-V3 segment of the vertebral artery in the mode, power Doppler mapping of blood flow obtained in a patient with ischemic stroke in stem structures of the brain with symptoms of pyramidal insufficiency and tetraparesis.

In Fig.1 additionally illustrates: 1 ultrasound scanner; 2 ultrasonic sensor; 3 sternocleidomastoid muscle; 4 - spinous process of the first cervical vertebra; 5 - the bottom edge of the occipital bone. In Fig.2 additionally shows: 6 - mastoid process of the occipital bone. In Fig.3 additionally shows: 7 - transverse process of the first cervical vertebra; 8 - distal part of the V3 segment of the vertebral artery. In Fig.4 additionally shows: 9 - transverse process of the second cervical vertebra; 10 - proximal part of the V3 segment of the vertebral artery.

The method of determining arterioles Doppler imaging of blood flow is carried out lying on his stomach with the support on the forehead, and the ultrasonic transducer is placed between the rear surface of the sternocleidomastoid muscle and the spinous processes of the first cervical vertebra so that the scanning plane is parallel with the bottom edge of the occipital bone. Then the sensor is turned clockwise and set between the lower edge of the mastoid process of the occipital bone and the transverse process of the second cervical vertebra so that the scanning plane is perpendicular to the bottom edge of the occipital bone.

A specific example of the method.

The proposed method for the determination of blood flow in the V3 segment of the vertebral artery (Fig.1, figs.2) is implemented on the ultrasound scanner 1, for example, Spectra Masters firms Diasonics, USA, with the ultrasonic sensor 2, for example, with an operating frequency of 5 MHz. The ultrasonic probe 2 is connected with an ultrasound scanner 1. Ultrasound scanner 1 allows to obtain an image V3 segment of the vertebral artery and blood flow in it mode, power Doppler mapping of blood flow.

During the examination the patient should be lying on his stomach, based on his forehead. On the scanning surface of the ultrasonic sensor 2 decrease in the on-mastoid muscles 3 and the spinous process of the first cervical vertebra 4, directly under the lower edge of the occipital bone 5, and the scanning plane is parallel to the bottom edge of the occipital bone, which allows you to display monitor ultrasound scanner 1, the image of the distal part of the V3 segment of the vertebral artery 8 mode energeticheskogo Doppler mapping of blood flow in the form of a strip shaped like the letter "U", which is painted in yellow color.

Then the sensor is turned clockwise and set between the lower edge of the mastoid process of the occipital bone 6 and the transverse process of the second cervical vertebra 9 so that the scanning plane is perpendicular to the bottom edge of the occipital bone 5 that allows you to display monitor ultrasound scanner 1, the image of the proximal part of the V3 segment of the vertebral artery 10 mode energeticheskogo Doppler mapping of blood flow in the form of a strip with a bend at an obtuse angle, which is painted in yellow color.

Clinical examples.

1. Determination of blood flow in the V3 segment of the vertebral artery was normal.

In accordance with the inventive method studied a group of healthy patients (27 men) aged from the RA distal portion of the V3 segment of the vertebral artery 8 was determined in the form of painted yellow stripes, shaped like the letter "U", and the proximal part of the V3 segment of the vertebral artery 10 in the form of a yellow coloured strip with a bend at an obtuse angle. A typical image of the V3 segment of the vertebral artery in color Doppler mapping of blood flow in normal conditions shown in Fig.5.

2. The circulation in the V3 segment of the vertebral artery pathology.

Patient S., 43 (outpatient map No. 486901), diagnosis: the late period of ischemic stroke in stem structures of the brain with symptoms of pyramidal insufficiency and tetraparesis. Sick for 2 months prior to the survey had suffered an episode of acute ischemic stroke. During examination of the patient by the claimed method of the proximal part of the V3 segment of the vertebral artery 10 on the monitor of the ultrasound scanner was determined in the form of a yellow strip shaped like the letter "C" with a bend at a sharp angle, the distal portion of the V3 segment of the vertebral artery 8 was determined in the form of a yellow strip shaped like the letter "U". The survey results indicated the change in the shape of the proximal part of the V3 segment of the vertebral artery 10, or violation of this blood vessel.

When investigated what we V3 segment of the vertebral artery.

Thus, the use of the invention allows to provide an objective visual assessment of blood flow in the basin V3 segment of the vertebral artery at the level between the transverse process of the second cervical vertebra and great occipital foramen, to determine the exact localization of violation of arterial blood flow, improve the quality of research, as well as to monitor treatment outcomes and the development of pathological processes by conducting repeated studies of arterial flow in the basin V3 segment of the vertebral artery.

The inventive method can be applied in the departments of diagnostic ultrasound, specialized classrooms ultrasonic diagnostic to determine the blood circulation in the V3 segment of the vertebral artery.

The inventive method of determining blood flow in the V3 segment of the vertebral artery is simple to use and provides a small investment of time for its execution.

Claims

The method for determining the blood flow in the V3 segment of the vertebral artery, including ultrasonic duplex scanning with the energy mapping of blood flow, characterized in that Cherie carried out in the prone position on his stomach relying on the forehead, and the ultrasonic transducer is placed between the rear surface of the sternocleidomastoid muscle and the spinous processes of the first cervical vertebra so that the scanning plane is parallel with the bottom edge of the occipital bone, and then, turning the sensor clockwise, position it between the bottom edge of the mastoid process of the occipital bone and the transverse process of the second cervical vertebra so that the scanning plane is perpendicular to the bottom edge of the occipital bone.



 

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FIELD: medicine.

SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.

EFFECT: high accuracy of diagnosis.

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