What Vascular Ultrasound Exam Should I Order?

Cerebrovascular EvaluationCarotid Bifurcation What exam should I order What exam should I order Carotid Bifurcation Clinical Indications
  • Stroke or TIA
  • Hemiparesis/hemiplegia
  • Numbness/tingling of skin
  • Facial weakness/droop
  • Aphasia, dysphasia or speech/language deficits
  • Amaurosis fugax or other visual disturbances
  • Dizziness, imbalance, loss of consciousness
  • Confusion
  • Carotid or supraclavicular bruit
  • Swelling, mass or lump in head or neck
  • History of TIA/stroke
  • Follow-up of known cerebrovascular disease
  • Follow-up of cerebrovascular surgery/intervention
 Peripheral Venous EvaluationPVEvaluations What exam should I order What exam should I order PVEvaluations Clinical Indications
    • Limb pain, swelling or tenderness
    • Limb cyanosis and/or erythema
    • Symptoms of pulmonary embolism (PE)
      • Abnormal lung scan
      • Respiratory abnormality (shortness of breath)
      • Acute respiratory failure
      • Chest pain
      • Hemoptysis
    • Induration/thickening of skin
    • Symptomatic varicose veins
    • Cellulitis
    • Venous ulceration
    • Localized superficial swelling, mass, lump, nodule
    • Follow-up of known DVT or superficial thrombosis
    • Post vein ablation exam
 Peripheral Arterial EvaluationPAEvaluations2 What exam should I order What exam should I order PAEvaluations2 Clinical Indications
  • Claudication
  • Rest pain (persistent severe resting foot pain)
  • Gangrene
  • Arterial ulceration
  • Non-healing surgical wound
  • Cyanosis in limb
  • Disturbance of skin sensation (e.g. numbness/tingling/burning)
  • Bruit or weak pulse in limb
  • Follow-up of known peripheral arterial disease (PAD)
  • Follow-up of PAD surgery/intervention
 Abdominal Aortic Aneurysm (AAA) EvaluationAVDEvaluations What exam should I order What exam should I order AVDEvaluations Clinical Indications
  • Abdominal or pelvic swelling, mass or lump
  • Pain in abdomen or lower back
  • Abdominal bruit
  • Follow-up of known AAA
  • Follow-up of AAA surgery/intervention

Medicare AAA Screening

  • Age 65-75 male or female with AAA family history
  • Age 65-75 male who has smoked ≥100 cigarettes
  • One time Medicare screening benefit
 Renal Artery EvaluationAVDEvaluations2 What exam should I order What exam should I order AVDEvaluations2 Clinical Indications
  • Hypertension (new onset or uncontrollable)
  • Epigastric or flank bruit in hypertensive patient
  • Increased creatinine or BUN
  • Follow-up of known renal artery stenosis
  • Follow-up renal surgery/intervention/transplant
 Mesenteric Artery EvaluationAVDEvaluations3 What exam should I order What exam should I order AVDEvaluations3 Clinical Indications
  • Abdominal pain associated with eating
  • Unexplained weight loss
  • Fear of food
  • Persistent diarrhea
  • Abdominal bruit
 Dialysis Vascular Access Siteav-fistula-anastomosis-stenosis What exam should I order What exam should I order av fistula anastomosis stenosis 282x300 Clinical Indications
    • Pre-operative exam for AV fistula or graft
    • AV fistula/graft surveillance
      • Change in the bruit or palpable thrill of the graft
      • Prolonged dialysis times
      • Elevated venous pressure found during dialysis
      • Difficult needle placement for dialysis
      • Underdeveloped fistula
      • Abnormal lab values
      • Perigraft mass
      • Arm swelling, and digital pain, numbness or tingling
 Hepato-Portal Evaluationhepato-portal-evaluations What exam should I order What exam should I order hepato portal evaluations Clinical Indications
  • Suspected portal hypertension with esophageal/bleeding varices
  • Abdominal pain
  • Abdominal distention
  • Ascites
  • Hepatic encephalopathy
  • Venous hum
  • Cruveilhier-Baumgarten Syndrome
  • Budd-Chiari Syndrome with sudden abdominal epigastric pain with nausea and vomiting
  • Hepatomegaly
  • Splenomegaly
  • Abdominal collateral vein distention
  • Follow-up post porto-systemic shunting (including TIPS – transjugular intrahepatic portosystemic shunting)

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