Method for diagnosing posterior tibial artery hypoplasia

FIELD: medicine.

SUBSTANCE: method involves applying ultrasonic triplex scanning in color Doppler mapping with linear multiple frequency transducer of 5-7-10 MHz being used. Longitudinal cross-section of the posterior tibial artery is produced from direct projection. Its diameter and intima-media complex thickness are measured. Doppler frequency shift spectrum is determined and resistance index is calculated. Tibial artery diameter being reduced by 0.16 cm or less, intima-media complex thickness being normal from 0.01 to 0.04 cm and resistance index being reduced less than 1,0, posterior tibial artery hypoplasia is to be diagnosed.

EFFECT: improved diagnosis quality.

6 dwg

 

The invention relates to medicine, namely to angiology, and can be used in clinical practice.

It is known that until recently, the main method is reliable diagnosis of lesions of the lower limb arteries remained radiopaque angiography [1]. However, this method has a number of significant disadvantages associated with diagnostic capabilities and its invasiveness. Angiography excludes the assessment of hemodynamic parameters and status of the vascular wall.

To diagnose this pathology of the arteries, as hypoplasia, a crucial role is played by information about the state of the vascular wall. This is due to the fact that the main manifestation of hypoplastic artery is uniform diffuse narrowing of the vessel lumen with an unmodified intima-media thickness (normal thickness). Diffuse narrowing of the arteries is also possible with such diseases as nonspecific aortoarteritis and thromboangiitis obliterans Burger [2]. However, the narrowing of the arteries in these diseases is caused by diffuse thickening of the artery walls, under normal external diameter of the vessel.

The objective of the method is to improve the diagnosis of hypoplasia of the posterior tibial artery.

The task to solve due to the fact that ultrasound triplex scanning the mode, color Doppler mapping applied linear multifrequency sensor 5-7-10 MHz and is obtained from the direct projection of the longitudinal section of the posterior tibial artery, measure the diameter and thickness of the intima-media complex, determine the range of Doppler shift frequencies and calculate the index of resistance and decreasing the diameter of the posterior tibial artery is less than or equal to 0.16 cm, normal thickness intima-media complex comprising from 0.01 to 0.04 cm, and the decrease in the resistance less than 1.0 diagnosed with hypoplasia of the posterior tibial artery. Experimentally in the study of 1660 the lower extremities of healthy people found that the thickness of the intima-media complex for posterior tibial artery is from 0.01 to 0.04 cm (average of 0.02±to 0.007, n=1660), the diameter of the artery is equal to from 0.17 to 0.32 cm (average of 0.25±is 0.04, n=1660), the resistance index greater than or equal to 1.0. When reducing the diameter of the posterior tibial artery is less than or equal to 0.16 cm, normal thickness intima-media complex comprising from 0.01 to 0.04 cm, and the decrease in the resistance less than 1.0 diagnosed with hypoplasia of the posterior tibial artery.

Using this method the study at 2850 people aged 16 to 83 years, were in the specialised departments of the Krasnoyarsk regional clinical hospital. Ultrasonic triplex scanning was performed with an ultrasonic system LOGIC-700 MR multifrequency linear transducer with a frequency scan 5-7-10 MHz. About is the introduction of the measurements was performed using the built-in ultrasonic system. The resistance index is calculated as the ratio of the difference between peak systolic and end diastolic velocity peak systolic [3]. The proposed method, three patients revealed hypoplasia of the posterior tibial artery.

Clinical examples

1. Patient Deltanine VA, 22 year history No. 3317. Did 12.02.02 to the neurology Department with a diagnosis of Osteochondrosis of the lumbar spine, radicular syndrome, Raynaud's syndrome. Complaints of pain, numbness, sensitivity to cold fingers of the right foot. When viewed noteworthy reduction of ripple on sidebartabs artery on the right. To exclude the occlusive-stenotic lesions of the right tibia segment of the patient conducted angiography of the arteries of the right lower limb (figure 1) - popliteal and anterior tibial artery passable, the lumen diameter of normal, the posterior tibial artery runs diffusely narrowed throughout. Suspected the presence of the patient obliterating thromboangiitis (Buerger's disease). Conducted triplex ultrasound scan (figure 2) - the diameter of the posterior tibial artery throughout of 0.14 cm, the thickness of the intima-media thickness of 0.02 cm, the resistance index 0,78. The diagnosis of hypoplasia of the right posterior tibial artery.

2. Sick Prytkov Y.A., 36 years. Case history No. 7734. On what was tupil 08.12.1999 in the vascular surgery Department with a diagnosis of occlusion of the right posterior tibial artery with an unclear etiology. On angiograms (figure 3) - diffuse narrowing of the right posterior tibial artery throughout. When triplex scanning (figure 4) stenosis of the posterior tibial artery throughout due to thickening of the intima-media complex to 0.06 to 0.08 cm, the diameter of the artery to 0.29 cm, the width of the blood flow of 0.11 cm, the resistance index of 0.83. The diagnosis of Thromboangiitis obliterans, stenosis of the right posterior tibial artery, ischemia 4th degree Pokrovsky. Patient was successfully operated - made arterialization of the venous blood flow of the right lower limb.

3. Patient Burakova B.C., 19 years old, outpatient map No. 8745. Turned on Advisory appointment with the vascular surgeon 31.10.99 with complaints of numbness, sensitivity to cold left foot and leg. When viewed from a lower ripple posterior tibial artery on the left. Ultrasonography (figure 5) - the diameter of the posterior tibial artery throughout 0,13 cm, the thickness of the intima-media thickness of 0.02 cm, the resistance index 0,88. The diagnosis of hypoplasia of the right posterior tibial artery.

4. Patient Anisimov NS, 29 years old, outpatient map No. 4582. Without clinical manifestations of ischemia of the lower extremities. The examination distinct pulsation of the arteries of the feet. The ultrasound triplex scanning 25.03.04 (6) - the diameter of the posterior tibial artery on all of protag the Institute of 0.23 cm, the thickness of the intima-media thickness of 0.02 cm, the resistance index of 1.40. Conclusion: data for occlusive disease of the arteries of the lower limbs not.

Thus, claimed as the invention method has a higher resolution. In three patients has not been verified hypoplasia of the posterior tibial artery, the method presented in the prototype, whereas with our method ultrasonic diagnostic detection of this pathology was achieved with a 100% frequency.

Using the data obtained by triplex scanning, it is possible to judge the presence of a hypoplastic posterior tibial arteries. The application of the developed technique extends the multifrequency linear probe in the evaluation of blood flow in the posterior tibial arteries. In terms of methodology, the use of triplex ultrasound scan simplifies diagnose narrowing of the posterior tibial artery.

Sources of information

1. Koelemay M.J., D.A. Legemate Interobserver variation in interpretation of arteriography and management of severe lower leg arterial disease// Eur. J. Vase. Endovasc. Surg. - 2001. - Vol.21, N5. - P.417 - 422.

2. Pokrovsky A.V. Clinical angiology. - M.: Medicine, 1979. - 386 S.

3. Leliuk VG, Leliuk SA Ultrasonic angiology. - M.: Real-Time, 2003. - 336 S.

Method for diagnosis of hypoplastic posterior tibial artery, by about the edenia triplex ultrasound scan characterized in that the ultrasonic triplex scanning mode color Doppler mapping applied linear multifrequency sensor 5-7-10 MHz and is obtained from the direct projection of the longitudinal section of the posterior tibial artery, measure its diameter and the thickness of the intima-media complex, determine the range of Doppler shift frequencies and calculate the index of resistance, and decreasing the diameter of the tibial arteries less than or equal to 0.16 cm, normal thickness intima-media complex comprising from 0.01 to 0.04 cm, and the decrease in the resistance less than 1.0 diagnosed with hypoplasia of the posterior tibial artery.



 

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