Anatomia aortei abdominaleAnatomia aortei abdominaleDiametru în jur de 20 mm

Traiect – rectiliniu, poate fi sinuos la vârstnici

Ramuri

•Parietale – a. diafragmatice inf., art. lombare (4 perechi)

•Ramuri viscerale

-tr. celiac - origine pe faţa ant a aortei, direcţie spre înainte, dă art. gastrică stgă, a hepatică comună, a splenică

- art. mezenterică superioară – de pe faţa ant a aortei, la cca. 10 mm sub tr. celiac; direcţie în jos

-A renale - de pe feţele laterale sub a. mezenterică sup

-A- testiculare / ovariene – pe faţa ant, între a renale şi mez inf

-A. mezenterică inferioară – faţa ant. a aortei la 5 cm înainte de bifurcaţie

-- a iliace

Tehnica examinăriiTehnica examinării

Pregătirea pacientului

Sondele folosite

Poziţia pacientului

Ecografia normala - aorta abdominalăEcografia normala - aorta abdominalăTub cu peretei fini, limen anecogen

Calibrul scade spre bifurcatie

Calibrul se masoara pe sectiune transversala – atentie sa nu inclinam sonda - supraevaluare

Ecografia normala - trunchiul celiacEcografia normala - trunchiul celiacPrimul ram important subdiafragmatic

Diametru 6 – 13 mm

Ramuri

- a hepatica comuna – directie spre dr

- a. splenic – diametru 4 – 8 mm, pe fata craniala a pancreasului,

deasupra venei splenice. In hil da 6 30 ramuri

- artera gastrica stga.

Se vizualizeaza bine pe sectiune sagitala si longitudinala

Variante anatomice

Doppler

- flux spre sonda

-Curba monofazica

-Viteza sistolica 90 -130 cm/s

Fig. 7.9 a The celiac trunk and supe rior mesenteric artery in sagittal sec tion, and b the celiac trunk as it branches into the common hepatic artery and splenic artery in a trans verse sectional plane. c A color-coded display of the flow in the celiac trunk and the proximal segments of the com mon hepatic artery and splenic artery. d A frequency spectrum from the distal section of the celiac trunk proximal to the origin of the common hepatic artery and the splenic artery, with a maximum systolic flow velocity of 166 cm/s and a Pourcelot resistance index of 0.74 (AO aorta, SMA superior mesenteric artery)

Fig. 7.9 a The celiac trunk and supe rior mesenteric artery in sagittal sec tion, and b the celiac trunk as it branches into the common hepatic artery and splenic artery in a trans verse sectional plane. c A color-coded display of the flow in the celiac trunk and the proximal segments of the com mon hepatic artery and splenic artery. d A frequency spectrum from the distal section of the celiac trunk proximal to the origin of the common hepatic artery and the splenic artery, with a maximum systolic flow velocity of 166 cm/s and a Pourcelot resistance index of 0.74 (AO aorta, SMA superior mesenteric artery)

,A color flow duplex sono gram of the splenic artery and a frequency spectrum obtained from the distal vascular segment, approximately 6 cm after its origin. A color change in the sample volume can be seen, which is due to aliasing, caused by an angle-related higher frequency shift during the color flow Doppler mode. There is no pathological flow acceleration. Maximum sys tolic flow velocity 92 cm/s, end-dias tolic flow velocity 37 cm/s, Pourcelot resistance index 0.60

Fig 7.12 a Sonogram of the origin of the left gastric artery (") from the celiac trunk (T) in transverse section (AO=abdominal aorta, SMA=superior mesenteric artery). b Subxiphoid transverse section, showing blood flow in the abdominal aorta (cross-section, blue color coding), with the origin of the celiac trunk proceeding

Ecografia normala - a. mezenterica sup.Ecografia normala - a. mezenterica sup.Origine pe fata ventrala a aortei, la 5 – 20 mm sub tr. celiac

Post. de pancreas

Traseu paralel cu peretele aortic

Pe sectiune transversala –imagine rotunda ant. de aorta; raportul cu vena renala stga

Diametru in segmentul proximal 8 – 14 mm; variaza cu digestia.

Se vizualizeaza bine pe sectiune sagitala si longitudinala

Examen Doppler –viteza variaza cu fazele digestiei

- a jeun = flux trifazic, V sist 90 -150 cm/s

- post prandial – creste diametrul, creste volumul de singe circulant, apare flux tip rezistenta scazuta

Fig.7.13 a Sagitta) section through the abdominal aorta, with the ventral origin of the superior mesenteric artery shown in the color-coded image. Aliasing is seen near the origin of the superior mesenteric artery. It is due to a steeper incident angle of the color flow Doppler beam. The flow direction is directed toward the transducer. Maximum systolic flow velocity 138 cm/s, end-diastolic flow velocity 13 cm/s, mean flow velocity 41 cm/s, Pourcelot resistance index 0.91, Gosling pulsatility index 3.03. b In M-mode, the walls of the aorta and the superior mesenteric artery are seen, with pulsatile and respiration-dependent movements. The diameter of the superior mesen teric artery is 7.4 mm

Doppler normal pe aorta abdominalăDoppler normal pe aorta abdominalăDeasupra artrerelore renale poate să aibă aspect de flux cu rezistebţşă scăzută

Sub arterele renale – flux trifazic , rezistenţă crescută

Vitezele normale intre 70 -140 cm/s

Doppler normal pe arterele visceraleDoppler normal pe arterele visceraleFlux tip rezistenţe scăzute

Vitezele in arterele viscerale sunt influentate de :•Miscarile respiratorii – cresc in inspir, cresc la Valsalva (Kamps et al. 1992) •Fazele digestiei – postprandial cresc V sistolica, V diastolica si calibrul art mezenterice sup si a tr. celiac•Agenti farmacologici – raspuns similar la glucagon, colecistokinina

Doppler colorDoppler color traseul arterelor viscerale – rareori rectiliniu

greu de urmarit pe tot traseul

schimbarile de directie – alternanta de culoare

dificultati legate de miscarile respiratorii si ale anselor intestinale

Doppler energieDoppler energieutil pentru teritoriile cu flux lent (in parenhim, tumori)

avantajos la vasele cu schiumbari dese de directie

sensibil la miscare

nu face distinctia intre artere si vene

PatologiaPatologiaStenoza, ocluzia

Anevrismul

Disecţia