Graft Doppler Protocol

Structure Scan Label Images Stored

Plane
Sagittal NATIVE NAME
Gray Scale
ARTERY Color Doppler
Native Artery
Color & Spectral Doppler of
native artery - measure PSV
Sagittal GRAFT AT PROX Gray Scale
Graft at Proximal ANASTOMOSIS Color Doppler
Anastomosis Color & Spectral Doppler of graft
- measure PSV
Sagittal GRAFT MID Gray Scale
Color Doppler
Graft
Color & Spectral Doppler of graft
-measure PSV
Sagittal GRAFT AT DIST Gray Scale
Graft at Distal ANASTOMOSIS Color Doppler
Anastomosis Color & Spectral Doppler of graft
measure PSV
Sagittal NATIVE NAME Gray Scale
Native Artery or ARTERY OR VEIN Color Doppler
Vein Color & Spectral Doppler of
native vessel measure PSV
Scan through each vessel prior to taking any images.

Tips

This is a very basic protocol. Depending on the length, location, and condition of the graft,
additional images may be required to document the graft in its entirety.

Grafts can connect arteries to arteries (for bypass) or arteries to veins (for hemodialysis
access)

Where the graft connects to the native vessel is called the anastomosis site.

Grafts can be located anywhere: arms, legs, abdomen etc.

Adjust protocol to each situation.
In addition to the images above, you must document any areas where there are increased
velocities.
Bypass grafts connect artery to artery
o Can be made of prosthetic materials or an autogenous vein
o Divert blood flow around an occluded segment of vessel
o Spectral waveforms and PSVs will vary depending on the location (what vessels it
connects)
Dialysis grafts aka dialysis fistulas connect artery to vein
o Can be made of prosthetic materials or an autogenous vein. Autogenous vein is the
preferred method and will be encountered most frequently.
o Located in the forearm or upper arm.
o A normally functioning dialysis graft will have PSVs between 150 and 300 cm/s and
EDVs between 60 and 200 cm/s
o The majority of complications will occur at the venous end/ distal anastomosis
Refer to the patient or the patients chart to get as much information about the graft as
possible before starting the exam (i.e. where is the graft located, what is it for/ what does it
connect, how long have they had it, when was it last evaluated, etc.)
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It is very important to compare velocities to previous studies. Review previous images/

reports whenever possible.

Color Doppler
Will vary with the presence/absence of pathology & curvature of the vessel or graft
Color images should relay the same information as your gray scale & spectral images
Color box should be steered (angled) with the vessel or graft direction
Color in a normal vessel/ graft should be free of aliasing and extend to vessel/ graft walls
Utilize preset color PRF (scale) and gain, and adjust according to the type of blood flow (velocities)
being imaged
If flow is normal and the color is outside the vessel wall or aliasing in center of vessel,
slowly increase PRF and/or decrease color gain until color is no longer outside the
vessel wall or aliasing.
If flow is normal and the color in the vessel is not filled in, slowly decrease PRF and/or
increase color gain until the color fills the vessel without aliasing or bleeding.

Spectral Doppler
Must use angle correct Angle correct must be less than 60 degrees
Gate (SV length) must be in center of vessel & small width.
Use color Doppler appearance to aid in placement of gate for spectral interrogation. Your
goal is to document the highest velocities present.
Set the PRF (scale) appropriately for the velocities imaged.
Adjust the PRF (scale) to display a large waveform.
Adjust the spectral gain so that there is no background noise on the spectral trace.
Elevated velocities with spectral broadening indicate a stenosis
Record velocities in the stenotic area as well as approximately 2 cm prior to (prestenotic)
and after (poststenotic) the area of stenosis
Stenosis is considered hemodynamically significant if the flow in stenotic area is twice the
velocity of an area just previous (prestenotic) to it

Pathology Seen

Document any retained valves in an autogenous vein graft.

Myointimal hyperplasia in a bypass graft
o Walls may appear slightly thick or normal
o Use color Doppler to evaluate for flow disturbances (aliasing)
o Use spectral Doppler to document highest velocities
o Occluded graft will have no color or spectral signals
Thrombus in a dialysis graft
o Will appear as intraluminal echoes with thickened walls
o Reduced flow lumen with a stenosis
o Use color Doppler to evaluate for flow disturbances (aliasing)
o Use spectral Doppler to document highest velocities
o Occluded graft will have no color or spectral signals
Document any soft tissue abnormalities seen in proximity to the graft (hematoma, abscess,
enlarged lymph nodes, etc.)
Document any pseudoaneurysms seen (size, residual lumen, and width of communicating
channel/ neck).
Document any intimal flaps/ dissections seen.

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Document any venous thrombosis seen.

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