Ultrasound is an essential diagnostic tool because of its safety, convenience and effectiveness. It produces images of the body's internal structures through the use of high-frequency sound waves, the echoes of which are used to create moving and still images. All images appear in "real" time as soon as the machine is turned on, and the transducer (a handheld device that sends and receives sound waves) placed on the body; there is no wait, as there is for X-rays and other imaging procedures, for images to be developed.
The abdominal aorta is the artery that runs through the middle of the abdomen, supplying blood to the lower half of the body. It can develop an aneurysm, which is a localized, balloon-like expansion caused by having weak walls. If an aneurysm is suspected, an abdominal aortic ultrasound, which provides information about blood flow through the aorta, may be performed. Detecting an abdominal aortic aneurysm is crucial because, if it ruptures, blood spills into the abdominal cavity, and death can result within a number of minutes.
Candidates for Abdominal Aortic Aneurysm Ultrasound
Although an abdominal ultrasound is recommended whenever an abdominal aortic aneurysm is suspected, regular screening is recommended for men aged 65 to 75 who smoke or used to smoke. In addition to being an older male smoker/former smoker, there are a number of risk factors for abdominal aortic aneurysm, including the following:
- History of atherosclerosis
- High blood pressure
- Having had an aneurysm in another artery
- Chronic lung disease
Women and men who have never smoked are not considered candidates for regular abdominal aortic ultrasound screening.
The Abdominal Aortic Aneurysm Ultrasound Procedure
A patient is asked to fast 8 to 12 hours prior to an abdominal ultrasound because getting clear images of the abdominal aorta may not be possible when there are food/liquids in the stomach, and urine in the bladder. The ultrasound procedure begins with the patient's lying down on an examination table. A water-based gel is applied to the abdomen. The gel allows consistent contact between the body and the transducer by eliminating any air pockets that could get in the way. The transducer is held firmly against the skin, and slowly moved back and forth across the abdomen; the images then appear on the computer screen. An abdominal ultrasound usually takes 20 minutes.
The duplex ultrasound is a diagnostic test administered to assess blood circulation. It combines the techniques of traditional ultrasound with those of Doppler ultrasound. Traditional ultrasound uses sound waves to create black-and-white images of the veins and arteries. Doppler technology, on the other hand, uses sound waves to track circulating blood, generating color images of blood as it flows through the body. Using this combination of techniques, duplex ultrasound helps to distinguish several important characteristics of the blood vessels, including speed and direction of blood flow and diameter of the vessels themselves. Duplex ultrasound can also detect the presence and extent of any obstruction in the blood vessels, such as cholesterol deposits or blood clots.
Types of Duplex Ultrasound
There are several different types of duplex ultrasounds that may be administered, depending on the patients symptoms and the region of concern. These types include:
- Duplex ultrasound of the abdomen
- Duplex ultrasound of the carotid artery in the neck
- Duplex ultrasound of the extremities
- Renal duplex ultrasound (of the kidneys)
For most types of duplex ultrasound examinations, no preparation is necessary, but patients undergoing an abdominal exam are typically instructed to fast after midnight prior to the test. It is important for patients to inform their doctors if they are taking any prescribed anticoagulants since these can affect test results. It is also necessary for the doctor to know whether the patient is a smoker because nicotine causes the arteries to constrict, altering test results.
Reasons for a Duplex Ultrasound
A duplex ultrasound helps the doctor visualize and measure blood flow to many regions of the body. It is useful in assessing the width of specific blood vessels and detecting any blockages and has the advantage of being less invasive than an arteriography or a venography. Duplex ultrasounds are administered to assist to diagnose or evaluate the following:
- Abdominal aortic aneurysm
- Arterial occlusion
- Carotid occlusive disease
- Deep vein thrombosis
- Renal function after transplant
- Peripheral arterial disease
- Renal vascular disease
- Varicose veins
- Venous insufficiency
Patients considered at high risk for circulatory problems are more likely candidates for a duplex ultrasound. This category includes smokers, diabetics, and those who are hypertensive or have high cholesterol.
The Duplex Ultrasound Procedure
During the examination, the patient wears a hospital gown and lies on a table. A gel that will assist in conduction is spread over the part of the body to be examined. The professional administering the test moves a transducer (wand) over the region being evaluated. The transducer emits sound waves; an attached computer measures the sound waves as they echo, creating images. The patient hears a swishing sound during the exam; this is the sound of the blood moving as it circulates through the blood vessels. The patient may experience slight pressure during the procedure, but there is not usually any discomfort. A duplex ultrasound takes about 30 minutes and is normally performed in a clinic or hospital setting.
Throughout most of the procedure, the patient lies still, but may to asked to change positions from time to time and to take and hold a deep breath. During a duplex ultrasound of the extremities, an ankle-brachial index (ABI) may need to be calculated. For this purpose, blood pressure cuffs will be placed on the patient's arms and legs. The ABI result is the number resulting from dividing the ankle blood pressure by the blood pressure in the arm.
Results of a Duplex Ultrasound
The results of a duplex ultrasound are evaluated carefully to detect any abnormalities in the affected blood vessels, such as plaque buildup or blood clots. There are no risks associated with the procedure. Depending upon the medical findings, other treatments, including possible surgery, may be necessary.