lets make a diagnosis………jeffline.jefferson.edu/jurei/conference/pdfs/vascular/may 16/8 - 1110...

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Patrick A Washko BSRT,RDMS,RVT,FSVU

Technical Director

North Carolina Heart and Vascular Hospital

UNC Rex Healthcare

Peripheral Vascular Laboratory

Raleigh, NC

Interesting Case Session

Leading Edge

Atlantic City 2019

Left

Groin

Left GroinLeft

Groin

Right Popliteal

AortaCeliac

SMA

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A Special Thanks To The :

UNC Rex Healthcare

North Carolina Heart and Vascular Hospital

Peripheral Vascular Lab Team

• S. Wayne Smith M.D.,RVT,RDMS,FSVM,RVPI

• Patrick A Washko BSRT,RDMS,RVT,FSVU

• Robert Mendes M.D

• Elvira Castellanos RDMS,RVT

• Otis Darden RDMS,RVT

• Dorian de Frietas M.D. RVPI

• Kelly Edwards BS RDMS

• Jason Kim M.D, RVPI

• Martyn Knowles M.D. RPVI

• Lauren Lissenden BS, RVT

• Anna Moore BS , RDMS, RVS

• Liliana Nanez M.D. RPVI

• Jim Morgan MS, RVT

• Lauren Estrada RDMS, RVT

• Brandy O’hara RDMS, RVS

• Olusegun Osinbowale, M.D. RVPI

• Hillary Sawyer RVT

• Daniel Sherrill RVT

• Daryl Smith MBA,RDMS, RVT

• Kristen Stahura BS RVT

• Brian Stull, RDMS,RVT

• Aaron Thomas, P.A.C, RVT

• Sharon Wertz RDMS, RDCS, RVS

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How Important Is Clinical History?

Lets Make A Diagnosis………

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• Patient called 911 from a hotel

• Patient was extremely confused

• Patient walked in bare feet and slept outside overnight during a recent snow storm

• Patient has been in hotel for 2-3 weeks and is now not able to walk and has no feeling

in his right finger tips nor bilateral feet

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• Patient called 911 from a hotel

• Patient was extremely confused

• Patient walked in bare feet and slept outside overnight during recent snow storm

• Patient has been in hotel for 2-3 weeks and is now not able to walk and has no feeling

in his right finger tips nor bilateral feet

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Frostbite

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• 17 year old

• Syncope while playing basketball

• Rushed in ambulance

• No pulses in legs

• Extreme pain

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Run Off

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Common Femoral Arteries

Right CFA Left CFA

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Superficial Femoral Arteries

Right SFA Left SFA

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Popliteal Artery Sagittal

Right Popliteal Artery

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Popliteal Artery Transverse

Right Popliteal Artery

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What Next ?

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Bilateral Common Iliac Arteries

Right Common Iliac Artery Left Common Iliac Artery

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What Next ?

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Aortic Thrombus

Distal Abdominal Aorta

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What Next ?

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Heart

Heart

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Echo

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Angiogram

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Intra-Operative and Post Op

Intraoperative Post Op

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• 48 year old female

• Pain LLE

• No Trauma

• No recent procedure

• Patient is a distance runner

• Recent extended travel

• Venous duplex ordered

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Distal Posterior Tibial Artery

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Saccular Posterior Tibial Artery Aneurysm

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Saccular Posterior Tibial Artery Aneurysm

B-Flow Transverse

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Correlation PTA

6-18-20136-19-2013

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Correlation PTA

6-18-2013 6-19-2013

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Angiography

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Correlation PTA

6-18-2013 6-19-2013

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PTA Aneurysm

6-20-2013

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Post Vein Patch

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Post Vein Patch U N

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Question

Does Anyone Ever Get the

request for a Stat Arterial and

Venous of a unilateral limb

Here?

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Acute Superficial Femoral Artery Embolus

Acute Femoral Thrombosis

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• 56 year old female

• Sudden left side weakness

• Visual disturbance right eye

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Right CCA

Proximal and Distal

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Right ICA

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Right ICAProximal

Right ICAMid

Right ICADistal

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Right ICA

M-SMI Circumventing Thrombus-Ruptured Plaque

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Right ICA

M-SMI Circumventing Thrombus-Ruptured Plaque

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Right ICA

M-SMI Circumventing Thrombus-Ruptured Plaque

Distal Right

CCA-

BifurcationRight ICA

Embolus – Ruptured Plaque

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• 67 year old

• Rushed to hospital in extreme chest pain with breathing issues

• No pulses in right leg

• Extreme pain

• Had a “ Procedure ” done 2 weeks ago on right leg not sure what

• I Think I had a tube put in my leg

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Left Superficial Femoral Artery Stent

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CDecreased Diastolic Flow Distal Disease

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CTA Left Carotid System U N

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Duplex Has Strengths and

Weakness’s….

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Two Right Renal Arteries

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What is Going On With This Patient ?

Same patient Contralateral Side

This is Intrarenal Segmental

Artery Assessment

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Intrarenal Flow Assessment U N

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Duplicated LRA

Feeding Mid and Lower Pole

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Draw Out Pathology !

Communication Is Always Key…

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Accessory Renal Arteries

Hey Pat,

Who did this patients

renal duplex last

month ?

They missed a

significant

Secondary renal

artery lesion……

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Patrick A Washko BSRT, RDMS, RVT, FSVU

Technical Director

North Carolina Heart and Vascular Hospital

UNC Rex Healthcare

Peripheral Vascular Laboratory

Raleigh, NC

Patrick.Washko@Unchealth.unc.edu

Thank You