bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodynamically Significant Carotid Disease in Duplex Ultrasound Patients with Carotid Artery Tortuosity
Authors: Hoskins Megan S. , Scissons Robert P. 
Published: March 2018

Purpose —Tortuous vessels are known to hinder the accuracy of extracranial carotid duplex ultrasound evaluations, yet the prevalence and location of hemodynamically significant lesions in these patients is relatively unknown. We evaluated the frequency and location of significant carotid occlusive disease in duplex ultrasound patients with carotid artery tortuosity. Methods —Data from consecutive patients for a 7-month period were prospectively entered into a database. Only initial studies were included in this study. Follow-up examinations, endarterectomy or stent vessels, and internal carotid artery (ICA) occlusions were excluded from analysis. Tortuosity was classified according to the angle of vessel curvature, i.e., between 60° and 90° (C1); 30° and 60° (C2); less than 30° (C3), and the location of the area of maximum stenosis in relationship to the area of tortuosity, i.e., pre- (S1), intra- (S2), or post- (S3) tortuosity. Lesions causing ≥50% diameter reduction (>125 cm/sec) were considered hemodynamically significant (HSIG). Results —A total of 200 patients and 370 vessels were analyzed. ICA tortuosity was found in 22% (82/370) of all vessels analyzed. Classification of the angle of vessel curvature for vessels with tortuosity was C1-50% (41/82), C2-40% (33/82), and C3-10% (8/82). HSIG disease was found in 17% (48/288) of nontortuous and 10% (8/82) of tortuous ICA vessels ( p = 0.172). The level of maximum stenosis preceded the area of tortuosity (S1) in all tortuous ICA vessels with HSIG disease. Conclusions —In this study, vessel tortuosity affected nearly a quarter of all vessels analyzed. The frequency of significant carotid disease was similar for patients with tortuous and nontortuous vessels. The location of maximum stenosis occurred before the area of curvature in all tortuous vessels with hemodynamically significant internal carotid artery disease, suggesting that this area should be the primary region of interest when evaluating duplex ultrasound patients with carotid artery tortuosity.
Case Study: Cystic Adventitial Disease of the Popliteal Artery
Authors: Shaw Meagan , Del Pizzo David J. , Pevec William C. , Holcroft James W. , Dawson David L. 
Published: March 2018

Introduction —Adventitial cystic disease is an unusual cause of lower-extremity ischemia. It affects large arteries, typically where the artery is near a joint space, and the popliteal artery is most commonly involved. Methods —A 60-year-old man with venous insufficiency and prior deep vein thrombosis was referred for a lower-extremity venous evaluation. He had chronic degenerative joint disease, with bilateral knee osteoarthritis, but a history of exertional right calf pain was elicited. His right femoral and popliteal pulses were normal, but the posterior tibial pulse was diminished and the dorsal pedal artery pulse was absent. A lower-extremity duplex ultrasound examination was performed, including conventional and panoramic B-mode imaging, color Doppler and power Doppler imaging, and pulsed flow assessment. Results —Chronic deep and superficial venous thrombosis was identified in the right lower extremity. During the examination, the right popliteal artery was noted to be abnormal. Imaging showed the flow lumen in the popliteal artery to be visibly narrowed by more than 50%. Peak systolic velocities (PSV) in the proximal popliteal artery were 82 cm/sec, with a normal triphasic waveform, but the PSV increased to 221 cm/sec through the stenotic segment. The luminal narrowing was limited to an approximately 3 cm segment of the popliteal artery. There was no visible plaque or evidence of vascular calcification. The lumen appeared compressed by hypoechoic, septated cystic material. There was no flow within the well-visualized cystic structure. The findings were subsequently correlated with arteriography. Adventitial cystic disease of the popliteal artery was diagnosed. The patient underwent successful right popliteal artery cystectomy. Intra-operative and post-operative duplex evaluations demonstrated normal findings. Conclusion —Cystic adventitial disease is a rare disorder that can compromise arterial perfusion to the leg and it is one nonatherosclerotic cause of intermittent claudication. In some cases, the popliteal artery may occlude. Incidental arterial disease may be encountered frequently with lower extremity venous duplex scanning. With a careful examination by a thorough technologist, rare and interesting pathology, such as cystic adventitial disease, is possible.
Iatrogenic Pseudoaneurysms: Optimal Management and Treatment Options
Authors: Hill Gerry , Albayati Sinan , Thomson Ian , Macfarlane Josie , Dutton Samantha , van Rij André M. 
Published: March 2018

Background Iatrogenic trauma is the most common cause of pseudoaneurysm. Several treatment methods are now available, including surgical repair, direct compression with the assistance of ultrasound, and ultrasound-guided thrombin injection. Each of these treatments has its own risks and advantages. Objective We sought to retrospectively assess the causes of pseudoaneurysm and the evolution of treatments and outcomes. Results Ninety-three pseudoaneurysms were diagnosed at Dunedin Public Hospital between September 1994 and December 2005, the majority resulting from cardiac catheterization. Fifteen patients were treated with ultrasound-guided compression, with a success rate of 66%. Sixty-three patients were treated with ultrasound-guided thrombin injection, with a success rate of 95%. No major or lasting complications were observed with either compression or thrombin injection; however, delayed diagnosis and treatment may have serious consequences requiring surgical salvage. Conclusions Ultrasound-guided thrombin injection is safe, effective, quick, and well tolerated by patients. It has become preferable to compression treatment and it is less invasive than surgical repair. Treatment should be given promptly upon diagnosis of the pseudoaneurysm rather than delaying with watchful expectation.
The Influence of Routine Duplex Scanning Surveillance on Outcome after Percutaneous Iliac Angioplasty and Stenting
Authors: Westerband Alex , Berman Scott S. , Brown Amy , Quick Rhonda C. , Mendoza Bernardo 
Published: March 2018

Purpose We sought to determine the utility of noninvasive color-flow duplex imaging (CDI) in the detection of iliac artery stenoses or occlusions and correlate the findings of long-term color flow duplex surveillance (CFDS) to clinical outcome after percutaneous iliac interventions. Methods All patients undergoing percutaneous iliac angioplasty and stenting are prospectively entered in a surveillance protocol with CFDS and ankle-brachial indices (ABIs) performed within 6 weeks, 6 months, 12 months, and every year thereafter. Preprocedural ABI and peak systolic velocity (PSV) values were compared with postprocedural values with the Student t-test. Kaplan-Meier life-table analysis was used to estimate the patency rates. Results During the last 4 years, 80 patients with 112 treated iliac systems fulfilled the study criteria. A total of 68 patients (84%) had claudication, 8 (10%) had pain at rest, and 5 (6%) had a nonhealing ulcer or gangrene. The procedural success rate was 96.4%. Comparison of ABIs and PSV values before and after iliac intervention was statistically significant ( p < 0.0001). Duplex scan allowed the detection and/or monitoring of abnormal velocities in 14 treated iliac arteries. Four cases (3.5%) required reintervention on previously treated iliac arteries for symptomatic restenosis and/or disease progression. Late stent occlusions were correctly identified in two cases. Primary patency, assisted primary patency, and secondary patency rates were 77%, 94%, and 96% at 4 years, respectively. Conclusion CFDS allows the detection of iliac artery stenoses and is a useful tool to identify restenosis after intervention. Because of the overall excellent patency rates observed with iliac angioplasty and stenting, CFDS surveillance in the absence of symptoms may not always be necessary and its long-term use should be individualized.
The Relationship between Velocity and Cerebral Resistance during Vasomotor Reactivity Testing: Should We Report a Different Measurement?
Authors: Byrd-Raynor Sheila , Alastruey Jordi , Hughes Alun , Thom Simon , Parker Kim H. 
Published: March 2018

Introduction and Objective Changes in arterial resistance are an important aspect in the regulation of cerebral blood flow. Vasomotor reactivity testing with transcranial Doppler (TCD) is used commonly to report findings in terms of mean flow velocity changes. Yet, the pertinent clinical question is about resistance changes. How effectively do the cerebral resistance vessels dilate and constrict, or what is their vasomotor capacity? In this study, we examine the relationship between cerebral flow velocity and resistance and propose a new measurement for vasomotor reactivity studies. Methods We recruited 35 healthy subjects and measured TCD mean flow velocities in the middle cerebral artery during vasoreactivity testing using 6% CO2 inhalation (hypercapnia) to produce cerebral vasodilatation, and controlled hyperventilation (hypocapnia) to produce vasoconstriction. Brachial blood pressure was also recorded. Mean Resistance (mean blood pressure/mean flow velocity) was calculated at baseline, hypercapnia, and hypocapnia. We compared the % change from baseline in both mean flow velocity (cm/s) and Mean Resistance (mmHg s/cm), in relation to gender and age. Results For the group overall, hypercapnia produced a 39.3 ± 19.9% increase in mean flow velocity; however, this resulted in only a 21.9 ± 9.9% decrease in Mean Resistance. Whereas during hypocapnia, a 32.4 ± 9.3% decrease in velocity produced a much larger increase in Mean Resistance (48.9 ± 22.2%). Young women had the greatest capacity to vasodilate, showing a 26.1 ± 9.2% decrease in Mean Resistance (46.0 ± 14.6% increase in velocity). However, young men showed the largest change during vasoconstriction; a 59.5 ± 31.6% increase in Mean Resistance (35.3 ± 9.5% decrease in velocity). Conclusions Large velocity increases during hypercapnia do not represent large changes in resistance. Whereas small velocity decreases during hypocapnia actually represent much larger changes in resistance, the calculation of Mean Resistance is a more clinically relevant measurement to report than velocity alone, and should be incorporated into TCD studies in the future.
Correlation between Renal Resistive Index and Estimated Glomerular Filtration Rate in Patients with Hypertension
Authors: Gaurav Kumar , Yalavarthy Umesh , Chamberlain Nathan , Pugh Sandra , Panda Mukta 
Published: March 2018

Introduction Renal resistive index (RRI) is a marker of flow resistance in renal parenchymal vessels. Kidneys may appear normal when imaged by ultrasound in early stages of chronic kidney disease (CKD). Several studies have shown that cortical echogenicity is not an objective way to assess CKD. Thus, if RRI correlates with estimated glomerular filtration rate (eGFR), it could serve as an additional predictor and objective measure of CKD. Currently to our knowledge studies assessing correlation between eGFR and RRI are lacking. Objective We sought to assess the correlation between RRI and eGFR. Methods In the 1-year study period, 874 abdominal Doppler examinations were performed in an accredited vascular laboratory by a single technologist. Analysis was performed for 310 Doppler results that met inclusion criteria. Serum creatinine was obtained from the electronic chart, and eGFR was calculated with the use of the abbreviated Modification of Diet in Renal Disease Study Group GFR equation. Results Statistical analysis using Pearson's correlation coefficient demonstrated a significant negative correlation between RRI and eGFR (r = −0.285, p < 0.01). Conclusion Our study serves as a pilot assessing correlation between eGFR and RRI. This correlation could serve as an early objective indicator of renal impairment as kidneys may appear normal by ultrasound in early stages of CKD.
Doppler Waveform Characteristics in the Celiac and Superior Mesenteric Arteries in Normal Children and Adults with the Use of Duplex Ultrasound
Authors: Asbeutah Akram M. , Buredha Bader , Mahmood Mustafa , Al-Mohana AbdulAziz 
Published: March 2018

Purpose To compare and contrast the flow patterns in celiac artery (CA) and superior mesenteric artery (SMA) in normal children to those in normal adults with the use of duplex ultrasound techniques. Methods Thirty male subjects were entered prospectively to the study. Peak systolic velocities and diameter at the origin of CA and SMA were recorded while the subject was fasting for at least 4–6 hr. The Human Ethics Committee at the Faculty of Allied Health Sciences-Kuwait University approved the study. Informed consent form was obtained from all subjects. Results There were 15 healthy male adults. Their average age (yr ± SD) was 22.7 ± 4.7 and their average body mass index (kg/m2 ± SD) was 23.5 ± 2.1. There were 15 healthy male children. Their average age (yr ± SD) was 7.2 ± 2.92, and their average body mass index (kg/m2 ± SD) was 18.5 ± 4.8. The average diameters (cm ± SD) of CA and SMA in adults were 0.73 ± 0.8 and 0.76 ± 0.11, and the average peak systolic velocities (cm/s ± SD) were 113 ± 17.5 and 145 ± 25.8, respectively. However, the average diameter (cm ± SD) of CA and SMA in children was 0.52 ± 0.06 and 0.53 ± 0.06, and the average peak systolic velocities (±SD, cm/s) of CA and SMA were 179.5 ± 39.5 and 175 ± 31.7. respectively. Paired student's t-test showed no statistical significance between the two groups. Coefficient of variation for diameter calculation and velocity measurement was <10%. Conclusion The peak systolic velocities in normal children at the superior mesenteric artery and celiac artery are slightly greater than in normal adults but it did not exceed 200 cm/sec in CA and 275 cm/sec in SMA. The Doppler waveforms are still within normal range in both groups despite the caliber of the vessels being smaller in children. Most probably greater velocities in children are caused by the high pressure of the transducer in superficially located vessel inducing flow disturbances.
Findings of Brain Death with the Use of Carotid Duplex Ultrasonography
Authors: Yesenko Sandra L. , Gornik Heather L. , Henion Dale , Bartholomew John R. 
Published: March 2018

Introduction Brain death is the complete and irreversible loss of cerebral and brain stem function. Although transcranial Doppler may be helpful in establishing the diagnosis, conventional carotid duplex ultrasound is not typically used in this condition. Case Report We describe the case of a 43-year-old woman with a past medical history of cardiac transplantation who was transferred from an outside hospital for hemodynamic monitoring and treatment. The patient had bladder surgery 1 day previously and suffered a prolonged cardiac arrest postoperatively. On arrival, she was comatose and ventilator dependent. Clinical examination revealed no brain stem reflexes (absent pupillary, corneal and oculocephalic reflexes). Brain death was suspected, although right upper-extremity flexion movements were noted. A carotid duplex ultrasound was ordered by the neurological service and performed using an Advanced Technology Laboratory HDI 5000 (Philips, Ultrasound, Bothell, Washington) machine with a linear 7–4 MHz transducer. Abnormal pulsed Doppler signals were detected demonstrating low velocity, bidirectional flow in the common and external carotid and the vertebral arteries. The internal carotid arteries demonstrated bizarre bidirectional and high resistive signals. Computed tomography showed diffuse cerebral edema and loss of gray-white matter differentiation. An electroencephalogram performed the next day demonstrated seizure activity correlating to her right upper extremity movements and indicative of some brain function retention. The patient died soon after. Conclusion Carotid duplex ultrasonography is not usually used in the diagnosis of brain death. Findings are characterized by a lack of diastolic flow or reverberating (to-and-fro pattern) flow and small systolic peaks in early systole on transcranial Doppler. This pattern is caused by a lack of adequate arterial perfusion. Cerebral angiography may reveal nonfilling of the intracranial arteries. Other diagnostic modalities, including computed tomography and electroen-cephalography, can be used with clinical findings to confirm brain death. In our case, carotid duplex ultrasonography was useful in assessing for brain death, although the patient (as later found) did not meet all neurological criteria. Vascular technologists should be aware of these unusual duplex findings in the evaluation of the comatose patient.
Differences in Venous Function of the Lower Limb by Time of Day: A Comparison of Chronic Venous Insufficiency between an Afternoon and a Morning Appointment by Duplex Ultrasound
Authors: Tarrant Gayle , Clarke Jill 
Published: March 2018

Objective To determine the importance of the time of the day in relation to the accuracy of duplex ultrasound studies of lower limb chronic venous insufficiency (CVI). Method Using duplex ultrasound techniques, 40 participants (48 limbs), which included 26 women and 14 men ranging from 24 to 76 years of age, were recruited. All participants tested positive to primary CVI in a 4- to 6-pm afternoon timeslot and returned the next morning between 8- and 9-am for a follow-up retest of their incompetent vein sites. Results A total of 32.5% (13) of participants or 29.2% (14) of limbs demonstrated a degree of change in results from incompetence in the afternoon to competent the next morning. Most significant were the perforator veins; 38% of those tested showed a change of results, followed by a 9% change in the short saphenous veins, a 2% change in the long saphenous veins, and no change was demonstrated from the alternative superficial vein pathways or the saphenofemoral/popliteal junctions. Conclusion Venous function can change from an afternoon to the next morning. The extent of venous incompetence is better diagnosed in the late afternoon, with the perforator veins most susceptible to a change of competence.
Customizable Ultrasound Career Ladder: A Preliminary Report
Authors: Jasa Randy P. , Kirkland John S. 
Published: March 2018

Purpose In 2005, Bureau of Labor Statistics growth projections for diagnostic medical sonographers were 27% during the next 5 years and recent surveys by the American Heart Association state that nationwide 42% of hospitals are reporting insufficient numbers of sonographers. Career ladders have been advocated for promoting professional development, stimulate certification, and to ensure employee longevity. We propose a vascular sonographer career ladder (VSCL) with specific objectives to document sonographer competency, reward certification, and stimulate long-term employment. Methods Vascular laboratory leadership and clinical administrators formed a committee to investigate and propose solutions to address staff retention and professional development. On the basis of recommendations from this committee, the Vascular Sonographer Career Ladder checklist was created. Results Before 2006, our vascular laboratory had an annual turnover rate of 20–30%. Upon implementation of the VSCL, there has been no vascular sonographer turnover. Conclusions Human resources experts state that employees want to feel challenged, engaged, and part of the team. It has established clear and easily modified objectives for defining sonographer competency, acts as a guide for achieving specific department and facility objectives, and has the flexibility to encourage individual initiative.
Patient Position and Phase of Respiration Affect the Doppler Waveform in the Celiac Artery
Authors: Asbeutah Akram M. , Al-Hussaini Abeer J. , Al-Otaibi Jawaher A. , Al-Nagi Mona N. , Al-Obaidi Saud 
Published: March 2018

Introduction Multiple factors might affect the velocity recording in the celiac artery (CA), causing a compression syndrome. Reports that focused on the phase of respiration found that the CA is highly compressed during the phase of expiration. Few reports in the literature have focused on body position during Doppler scanning of the CA. The aim of this study was to evaluate the effect of patient position as well as the phase of respiration on velocity recording in the CA. Methods Thirty male subjects were entered prospectively into the study. Peak systolic velocity and vessel diameter at the origin of the CA at different body position and different phases of respiration were recorded by the use of duplex ultrasound while the subject was fasting. Results There were 30 healthy men; their average age was 25.5 ± 5.30 (±SD, years), and their average body mass index was 24.8 ± 3.1 (±SD, kg/m2). The average diameter of CA in supine position and expiration was 0.70 ± 0.10 (±SD, cm), and the average peak systolic velocity was 111.2 ± 29.7 (±SD, cm/s). Moreover, the average diameter of CA in standing position in expiration was 0.75 ± 0.10 (±SD, cm), and the average peak systolic velocity was 96.8 ± 25.2 (±SD, cm/s). Paired Student t test for the effect of body position and phase of respiration in the peak systolic velocities and the diameter of the CA was performed and demonstrated statistical significance ( p < 0.05). Conclusion The CA peak systolic velocity varies between 2 positions in healthy young men, which may have implications for disease detection and needs further study.
Carotid Plaque Characterization with Contrast-Enhanced Ultrasound Imaging and its Histological Validation
Authors: Molinari Filippo , Liboni William , Giustetto Pierangela , Pavanelli Enrica , Marsico Andrea , Suri Jasjit S. 
Published: March 2018

Introduction Better methods are needed to determine the course of intervention in patients with atherosclerosis; therefore, plaque characterization is increasing in importance. Current guidelines suggest that the degree of stenosis and symptoms are the only criteria for the selection of the surgical intervention. However, there remain some challenges. The characterization of plaque morphology may help determine the best course of therapy. Magnetic resonance imaging and computed tomography are current standard techniques to evaluate plaque morphology, but they are expensive and unsuitable for long term surveillance and monitoring. Objective In this research, an ultrasound-based methodology for the characterization of carotid plaques is shown. This technique requires the injection of a small volume (approximately 1.5 mL) of contrast agent and the acquisition of postcontrast images. The rationale of this technique is that poorly perfused tissues (such as lipids) show a lower contrast enhancement with respect to highly perfused tissues (such as fibrous and muscular tissue). Methods The technique consists of two steps. First, the plaque region is automatically segmented by a completely user-independent algorithm. Then, the portion of the wall corresponding to the plaque is analyzed and color-coded intensity is assigned to a specific tissue. Performance evaluation was performed against histology. Twenty plaque specimens were sent to pathology for reporting. Correlation of the histology report and of the contrast-enhanced ultrasound analysis was performed. Results Plaque components that could be effectively identified were thrombi, lipids, fibrous/muscular tissue, and calcium. Overall the errors on 20 plaques between automated classification and histology were: 3.1 ± 1.1% for thrombus, 4.2 ± 1.5% for lipids, 5 ± 3.4% for fibrous/muscular tissue, and 3.2 ± 1.0% for calcium. Conclusion Despite the need for further investigation and a quantitative evaluation of the results, this methodology showed encouraging results. This analysis architecture is undergoing validation in a neurology division and is aimed at being used for the follow-up of patients and quantification of drug therapy effects.