0:01

So now, and again, I a full disclosure,

0:03

we don't do a full RTL evaluation.

0:07

Uh, we didn't do it at, at Hopkins.

0:09

We don't do it NYU, that's for the vascular lab.

0:12

So we don't do, uh, a, uh,

0:14

ankle brachial indices and, and stuff like that.

0:16

But what I wanna share with you is maybe

0:20

abnormal doppler spectrum

0:21

that also indicate either occlusion or stenosis.

0:25

So if you have arterial occlusion at the segment itself,

0:30

you have, you can either see the clot or,

0:34

and often the clot can be echogenic

0:35

and you will have no flow proximal

0:40

to the occlusion.

0:41

So more above the occlusion, more centrally, uh,

0:46

you are gonna see a sharp systolic up stroke,

0:49

and the flow should be, often should be biphasic.

0:51

Sometimes it's monophasic. So you have a hint.

0:53

This is a femoral vessel, right?

0:55

So the, it should be phasic, very high resistant flow.

0:59

So you may have a hint, but maybe this is not normal,

1:03

but you have a short systolic up stroke,

1:05

and again, distal to the occlusion.

1:07

So this is more distally.

1:10

You'll have this parve starters wave form.

1:13

And that's an important thing to keep in mind.

1:17

Just a word about acute ischemia.

1:20

I've shown you a couple of example that really the viability

1:22

of the limb because the patient does not have time

1:25

to develop collateral vessels.

1:26

So patients usually, typically will present

1:28

with acute severe pain.

1:31

You may have discoloration of the limb,

1:33

you may have decrease of or absent distal pulses,

1:37

and that's really a surgical emergency, right?

1:39

Uh, the patient needs to see a vascular surgeon immediately.

1:43

Some, uh, etiology, embolus, uh, thrombosis,

1:48

dissection, which can be spontaneous or posttraumatic,

1:51

and much less commonly vasculitis

1:53

or low flow state, that's a little bit less common

1:55

because oftentimes this patient have time

1:57

to develop some collateral vessels.