bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carotid Aneurysm: A Case Study
Authors: Pazienza Kathryn J. , Duke Rhonda I. , Whitehouse W. M. , Higginbotham Candace 
Published: March 2018

Introduction A 73-year-old woman presented to the vascular laboratory for evaluation of a right-sided neck mass. This case study details the course of her evaluation and the need for using carotid duplex in a complete work-up. The patient had noted a mass over several months, but it was asymptomatic. Case Report The patient had a computed tomography scan at an outside institution, which showed an intensely enhancing lesion within the right carotid bifurcation, measuring 2.9 cm × 2.1 cm. The study was interpreted as a carotid body tumor and was referred for surgical consultation. A carotid duplex exam was ordered for further definition of the lesion. The carotid duplex exam revealed a 2.7-cm × 2.5-cm mass within the carotid bifurcation, which appeared to be a carotid aneurysm. A cerebral angiogram was obtained, which confirmed the diagnosis of carotid aneurysm. Conclusion Aneurysms of the extracranial carotid arteries are uncommon arterial lesions. Many different modalities may be used when evaluating a carotid mass, but this case demonstrates the importance of carotid duplex scanning.
Changes in Perforating Vein Reflux after Saphenous Vein Ablation
Authors: Parks Tara , Lamka Christine , Nordestgaard Aksel G. 
Published: March 2018

Introduction This prospective duplex study evaluates what percentage of perforators remains incompetent after saphenous vein ablation by endovenous laser ablation (EVLT). Methods Patients with venous disease, incompetent perforating veins (IPVs), and saphenous vein reflux identified on initial duplex ultrasound exam were included. Perforators were re-evaluated 3 days postoperatively for size and competency. Results One hundred patients with a mean age of 53 years with incompetent saphenous veins and a total of 169 IPVs were included. Of the 169 initially incompetent perforators, 92 (54.4%) became competent, 21 (12.5%) occluded, and only 56 (33.1%) remained incompetent after the EVLT procedure. When grouped by diameter, 25 (89.29%) of small-diameter perforators (<3 mm), 49 (62.03%) of medium-diameter perforators (3–4 mm), and 18 (29.03%) of large-diameter perforators (>4 mm) became competent after the EVLT procedure. Only 3 of the 28 (10.7%) small-, 23 of the 79 (29.1%) medium-, and 30 of the 62 (48.4%) large-diameter perforators remained incompetent after the EVLT procedure. Preoperative perforator diameter was a determining factor in reversal of reflux ( p < 0.0002). Conclusion Only 33% of all initial incompetent perforators remained incompetent after the EVLT procedure. Reversal of incompetence was size dependent.
Ultrasound-guided Thrombin Injection for Gluteal Pseudoaneurysm Resulting from Trans-sacral Drain Removal
Authors: Harthun Nancy L. , Ripplinger DeeAnn 
Published: March 2018

Introduction Thrombin injection for the treatment of arterial pseudoaneurysms has been performed safely and effectively for many years. These pseudoaneurysms typically develop after a performance of a percutaneous procedure that uses the common femoral artery for access. This technique has also been applied effectively for pseudoaneurysms arising from other arteries. This report presents the first use of thrombin injection technique with ultrasound guidance for ablation of a gluteal pseudoaneurysm. Case Report A 44-year-old man presented with complicated diverticulitis and was treated with two operations. Afterward, he had an infected pelvic fluid collection that was drained with computed tomography-guided, trans-gluteal approach. After drain removal, pain developed in the right buttock, and a gluteal pseudoaneurysm was diagnosed, which was successfully treated with an ultrasound-guided, thrombin injection. Conclusions Complications resulting from trans-gluteal drainage are unusual. Pain and hemorrhagic complications have been documented and are more common when a transpiriformis muscle approach is mandated by location of the fluid collection. Thrombin injection provided a rapid, safe, and effective treatment for this complication. This approach required no significant anesthesia and recovery was less than 2 days. Ultrasound demonstrated clearly that the gluteal fluid collection was a pseudoaneurysm and that it demonstrated characteristics favorable for thrombin injection.
Alterations of Flow-Mediated Dilation of the Brachial Artery in Women after Menopause
Authors: Montenegro Carlos Antonio B. , Mathias Marcia L. , Leite Sandra P. , Garrido Karla U. , Salles–Cunha Sergio X. 
Published: March 2018

Introduction Risk of cardiovascular diseases increases after menopause. Decrease in estrogen alters endothelium function, the first event in the atherosclerotic process. Endothelium function can be assessed by flow-mediated dilatation (FMD) during reactive hyperemia. We compared differences in brachial artery FMD in women before and after menopause. Methods Average ages of control (n = 35) and postmenopausal (n = 38) women were 34 ± 8 (SD) and 57 ± 7 years respectively. No subjects were on estrogen therapy or had known risk factors for cardiovascular disease. Brachial artery FMD was measured 5 cm above the cubital crease, using a 14 MHz transducer. B-mode images were selected during diastole using the flow waveform. Diameter measurements were performed before brachial artery occlusion and 60 seconds after release of a 5-min occlusion accomplished with pneumatic cuff inflation. FMD expressed the percentage change in diameter during reactive hyperemia versus baseline. Results Average FMD was 19 ± 6% (11 – 30%) for controls, decreasing significantly to 14 ± 6% (3–26%) post-menopause ( p < 0.001 by t-test). FMD was abnormally lower than 10% in 9 post-menopausal women, 7 older than 60 years, and 8 with menopause ≥10 years. Conclusions FMD decreased significantly post menopause and were abnormally low in older women with longer menopause. Changes in FMD with age, duration of menopause and relation of low FMD to risk development deserves further investigation to determine if FMD can be used as an independent risk factor.
Prevalence and Patterns of Small Saphenous Vein Reflux
Authors: Neuhardt Diana L. , Salles–Cunha Sergio X. , Morrison Nick 
Published: March 2018

Objective The small saphenous vein (SSV) often is a forgotten source of venous valvular insufficiency signs and symptoms or is a “victim” of unwillingness to treat. Either way, ultrasound (US) frequently focuses on the great saphenous vein without an equivalent thorough evaluation of the SSV. We investigated the prevalence and patterns of SSV reflux during a voluntary service to the community of Santiago de Guayaquil in Ecuador. Methods Patients were screened for SSV reflux while standing. A portable laptop scanner was used to examine the SSV at the proximal, mid, and distal calf (positions A, B, and C) in 410 legs of 205 subjects. Although all patients were C1 – C6 according to the clinical CEAP (i.e., clinical severity, etiology or cause, anatomy, and pathophysiology) classification, 14% of the legs were C0. Forward and reverse flows were noted after a variety of manual compressions. Only severe reflux lasting longer than 4 seconds is reported herein. Results The prevalence of SSV abnormalities was 17% (69/410). Reflux was noted in 54 (13%) of the extremities whereas in 15 (4%), the SSV did not have reflux but was intertwined with the pathways of varicose veins. The diameters of the refluxing veins were related to the location and extent of reflux. The most common pattern was reflux in the A, B, and C positions (n = 17) of SSV averaging 4.6 (A) to 4.4 mm (C) in diameter. Reflux was noted in the AB, A, and B positions in 10, 11, and 12 SSV, respectively; diameters of these veins averaged 4.1 (A) to 3.7 mm (B), 4.1 mm (A), and 3.4 mm (B). SSV reflux in the B and C and C only positions were least common (n = 4), noted in veins averaging 2.5 mm in diameter. Varicose veins interconnected with short SSV segments were noted in all three positions (A, B, and C) in seven legs whereas in eight legs the varicosities were segmental, most commonly in the B position (n = 6). Conclusions The prevalence of SSV abnormalities was significant. SSV reflux or connection to varicose veins was noted in close to one of five legs. The SSV should be evaluated at least at the proximal and mid calf to avoid missing significant reflux.
Ultrasound and Computed Tomography-Guided Thrombin Injection of a Type 2 Endoleak
Authors: Wilson Stephanie R. , Atnip Robert G. , Singh Harjit , Wilson Ryan H. , Zang William A. 
Published: March 2018

Introduction Type II endoleaks are a well-documented complication of endovascular aortic aneurysm repair. This case demonstrates the successful combined use of duplex ultrasound to assist in the percutaneous treatment of type II endoleaks. Case report A 75 year-old man who had previously undergone endovascular aortic aneurysm repair was found to have a type II endoleak. As the result of failure of the transfemoral endovascular coil embolization to repair the leak, the patient underwent computed tomography-and ultrasound-guided thrombin injection of the aneurysm sac via a trans-lumbar approach. Duplex ultrasound proved useful in guiding the placement of the translumbar needle, in confirming the thrombosis of the endoleak, and in demonstrating continued patency of the endograft. Conclusion The two imaging modalities worked in a complementary fashion to guide needle placement and to enable real-time imaging of color-enhanced flow within the aneurysm sac.
A Rare Axillary Artery Aneurysm with Limb-Threatening Ischemia
Authors: Grimm Jodi J. , Tran Nam 
Published: March 2018

Introduction Isolated subclavian or axillary artery aneurysms are extremely rare, accounting for less than 3% of peripheral aneurysms. These aneurysms can be caused by a secondary infection such as syphilis, trauma, Ehler – Danlos syndrome, poststenotic dilation from thoracic outlet obstruction, arthrosclerosis, or congenital reasons. They are at risk for rupture, distal embolism, and thrombosis. These complications can cause limb loss and or death. Case Report An 80-year-old woman presented to the emergency room with a cold left upper extremity. The patient had a history of atrial fibrillation, congestive heart failure, and hypertension. A presumptive diagnosis of peripheral emboli was made because of the patient's atrial fibrillation and recent myocardial infarction. She was taken to the operating room for a thrombectomy of the left brachial, radial, and ulnar arteries. At that time, a pulsatile mass was noted on the patient's shoulder, and an ultrasound was ordered. The ultrasound revealed a left axillary artery aneurysm measuring 3.62 cm anteroposteriorly x 3.72 cm transverse. There was nonocclusive thrombus within the lumen of the aneurysm. There was diminished, monophasic flow in the axillary and brachial arteries. Postoperatively the patient was placed on intravenous heparin. She was taken back to the operating room where a 7-mm Dacron graft was placed between the left axillary and brachial artery with exclusion of the axillary artery aneurysm. On postoperative duplex the bypass graft was patent. The patient did not suffer any long-term complications as the result of ischemia. Conclusion Although upper-extremity aneurysms are rare, and little is known about the natural history, there are multiple documented limb-threatening and or life-threatening complications. It is essential that they be treated in a timely manner as to avoid limb-threatening complications. An ultrasound can provide a noninvasive method of detecting a subclavian-axillary aneurysm. It can be used to screen patients when there is a suspicion of an aneurysm and determine the presence of concomitant thoracic or abdominal aneurysm.
Incidental Finding of Asymptomatic Aortic Dissection
Authors: Goh Elaine Y. L. , Ng Shirley C. K. , Chao Victor T. T. , Ding Zee P. 
Published: March 2018

Introduction Aortic dissection limited to the abdominal aorta is not common. This case report describes the role of duplex ultrasound in the diagnosis of asymptomatic dissection of the abdominal aorta. Case Report A 59-year-old man with hypertension and mild renal impairment was referred to the vascular laboratory for color ultrasound examination of the renal arteries to rule out renal arterial stenosis. The ultrasound examination revealed a nonsignificant (<60%) stenosis in the right renal artery and two thickened but patent left renal arteries; however, there was an incidental finding of dissection of the abdominal aorta arising from the level of the celiac trunk down into the iliac arteries. Magnetic resonance imaging of the thoracic and abdominal aorta was requested; contrast was not used in view of the patient's deteriorating renal function. The finding revealed no features to indicate dissection in the thoracic or abdominal aorta. In view of the discrepancy in findings, computed tomography aortogram was performed. Dissection of the abdominal aorta just distal to the origins of the renal arteries was seen. This case study details the high sensitivity of color ultrasound imaging in identifying abdominal aorta dissection. Conclusion Color duplex ultrasound may be operator dependent but it is a highly sensitive and cost effective modality for identifying abdominal aortic dissection.
Duplex Ultrasound Mapping Protocol for Placement of Cardiopulmonary Bypass Cannulae for Robotic Mitral Valve Surgery
Authors: Grattan Alia G. , Digiannantonio Alexa , Mihaljevic Tomislav , Gillinov A. Marc , Gornik Heather L. 
Published: March 2018

Background Duplex ultrasound is a noninvasive, low-cost modality for evaluation of lower-extremity arteries and veins. We developed a protocol to evaluate the lower-extremity vasculature for patients who may undergo robotic mitral valve repair that requires placement of cardiopulmonary bypass cannulae in the common femoral artery and vein. We report our early experience with this mapping protocol. Method The protocol includes imaging of bilateral distal external iliac, common femoral, and femoral arteries and veins. Documentation includes minimal vessel diameter at each segment, the presence of stenotic or calcified plaque, and lumen diameter in the presence of protruding atheroma. Bilateral ankle-brachial indices are recorded. Results During the period October 9, 2009 to February 4, 2010, we performed 100 mapping protocol studies. Mean patient age was 57.2 years (range, 20–84 years), and 65% were men. The presence of vascular calcification was noted in 34% of patients. No patient had hemodynamically significant arterial stenosis or deep-vein thrombosis. Mean lower-limb ankle-brachial indices were 1.13 (range, 0.90–1.34). Intraoperative common femoral artery and/or common femoral vein diameter measurements were available for 15 patients who underwent robotic surgery. Among this sample, there was no statistically significant difference between ultrasound mapping measurements and intraoperative diameter measurements (common femoral artery: 0.99 cm ultrasound versus 1.03 cm intraoperatively, p = 0.29; common femoral vein: 1.06 cm ultrasound versus 1.09 cm intraoperatively, p = 0.82). Conclusion Our surgical colleagues have found these mapping procedures to be useful in selecting candidates for robotic surgery and in planning the procedure. Duplex ultrasound is a useful and accurate tool for evaluating patients for robotic cardiac surgery requiring femoral cannulation for cardiopulmonary bypass.
Clinical Significance of Standing versus Reversed Trendelenburg Position for the Diagnosis of Lower-Extremity Venous Reflux in the Great Saphenous Vein
Authors: DeMuth R. Patrick , Caylor Kathy , Walton Tina , Leondar LuAnne , Rosero Eric , Chung Jayer , Arko Frank , Clagett G. Patrick , Valentine R. James 
Published: March 2018

Introduction Sonographic detection of incompetence in the deep and superficial veins requires proper patient positioning. Although these tests have been traditionally performed in the reversed Trendelenburg (RT) position, recent mandates from The Intersocietal Commission for the Accreditation of Vascular Laboratories and some insurance providers require that patients be evaluated for reflux in the standing position (SP). The purpose of this study was to determine whether performing venous duplex in the SP versus RT position adds information that affects patient treatment. Methods Twenty-eight subjects (25 women; mean age of 52 years) with signs and symptoms of venous insufficiency were evaluated prospectively with the use of ultrasound imaging and Doppler in the 5- to 8-MHz ranges. The great saphenous vein (GSV) was evaluated for each limb from below the knee to the saphenofemoral junction. Patients were initially evaluated at 15–25 degrees of RT position. Reflux was defined by reversal of flow for >0.5 seconds via use of the Valsalva and/or manual compression maneuvers. The GSV was measured in A-P diameter at the saphenofemoral junction and at the knee level. The subjects were then elevated to SP and measurements were repeated while the limb was in a nonweight-bearing position. Results A total of 52 limbs were evaluated for venous reflux in 28 study subjects. The mean lower-extremity CEAP score was 3 SD ± 3. Twenty-six (50%) GSVs were positive for venous reflux in the RT position. Of these GSVs, three were negative for reflux in SP. Twenty-seven (53%) GSVs were positive for venous reflux in SP; however, four of these GSVs were negative for reflux in RT. The median difference in reflux time from RT to SP was 0.15 seconds (interquartile range 0–3.8 seconds and 0–2.7seconds, respectively, p = 0.02). The mean difference in GSV diameter from RT to SP was 0.7 mm (±0.96 mm SD, p < 0.0001). These results changed the clinical course for one subject who did not have reflux in RT but did in SP (3.5%, p = 0.085). Conclusion The results from evaluating subjects in SP were not independently associated with a change in clinical outcome. However, 15% of GSVs negative for reflux in RT were positive for reflux in the SP. As a result, 3.5% of subjects in our study had a change in clinical course as the result of evaluation of the GSV in SP. This finding suggests that failure to identify GSV reflux in RT in patients with signs and symptoms of venous insufficiency may be an indication to evaluate the GSV in SP.
Internal Carotid Occlusion in a Newborn
Authors: Blackburn Donna R. 
Published: March 2018

The vascular laboratory was called to the neonatal intensive care unit to perform a carotid duplex examination on a 2-day-old infant. This term female newborn was delivered via caesarian because of labor that failed to progress. There were no significant maternal risk factors. On day 2, the infant was noted to have seizures. Magnetic resonance imaging of the brain demonstrated a large left hemispheric infarct with a midline shift. The findings of an echocardiogram were normal. The carotid system was evaluated by the use of a “hockey stick” 15–7 MHz linear array transducer. The common, external, and internal carotid arteries were well visualized bilaterally, as well as the vertebral and subclavian arteries. The right side was normal. The left common carotid artery signal was high resistance and a drumbeat, high resistance signal was noted at the origin of the internal carotid artery. The internal carotid artery appeared to be filled with soft echoes, and no signal was detected within the internal carotid artery beyond the origin. The infant was then transferred to Children's hospital for further evaluation and possible tissue plasminogen activator treatment. Neonatal cerebral infarction has been reported to be present in 1 in 4,000 full-term infants. Neonatal cerebral infarct was found in 12% of infants who developed neonatal seizures. Newborns with arterial ischemic stroke usually present with seizures. Primary risk factors for arterial ischemic stroke include cardiac disease, perinatal complications, and other acute illnesses, including dehydration and prothrombotic disorders. Mortality rates after arterial ischemic stroke in newborns are less than 10%. In many cases, the outcome is normal. Duplex imaging of the carotid vessels is feasible in neonates and can provide the treating physician with valuable diagnostic information.
Duplex Ultrasound Diagnosis of an Arteriovenous Fistula between the Left Subclavian Artery and the Left Internal Jugular Vein after Attempted Central Venous Catheter Placement
Authors: Venitelli Zeah , Holtman Chelsea , Mack Aisha , Gahtan Vivian , Costanza Michael J. 
Published: March 2018

Introduction —An arteriovenous fistula between the subclavian artery and the internal jugular vein represents a rare iatrogenic injury that has almost exclusively been described on the right side. We describe the case of an arteriovenous fistula between the left subclavian artery and the left internal jugular vein after attempted central venous cannulation. The initial duplex ultrasound exam established the definitive diagnosis. Patient Description —A 72-year-old man had a central venous catheter inadvertently placed in the arterial system during attempted cannulation of the left internal jugular vein. After the catheter was removed, a duplex ultrasound exam of the left common carotid artery was requested to evaluate for injury. Methods —A carotid duplex ultrasound exam was performed using an Acuson Antares Ultrasound System with a VFX 9–4 MHz probe. The left common, internal, and external carotid arteries were evaluated with grayscale imaging; color Doppler, and spectral flow analysis. The left vertebral artery and subclavian arteries were also evaluated sonographically. Results —The duplex ultrasound did not detect an injury to the left common carotid artery; however, a color flow bruit was noted in the surrounding tissue. Further investigation clearly demonstrated a high-flow vascular communication between the left subclavian artery and the left internal jugular vein consistent with an arteriovenous fistula. The arteriovenous fistula was treated with an endovascular intervention that involved placing a stent graft in the left subclavian artery to cover the arterial origin of the arteriovenous fistula. The completion arteriogram and follow-up duplex ultrasound showed that the stent graft completely excluded the arteriovenous fistula. Conclusion —This case describes an extremely rare iatrogenic arteriovenous fistula between the left subclavian artery and the left internal jugular vein. The images obtained with duplex sonography were detailed enough to definitively diagnose the injury and plan for treatment.
Determining the Significance of Reversed Flow in the Internal Carotid Artery
Authors: Green Judi 
Published: March 2018

Introduction —Carotid duplex ultrasound continues to be the most precise and cost-effective noninvasive technique for the assessment of the extracranial arterial system. Two-dimensional imaging, color Doppler, and spectral analysis can be used to quickly assess and support the monitoring of those patients at risk for stroke. Clinically, this effective technique of patient assessment has proven itself in preventative as well as in postevent treatment. Case Study —The patient focused in this case study is a 79-year-old man whose diagnosis was bruit. Based on the diagnosis and risk factors, a carotid duplex was performed. Conclusion —This report demonstrates the importance of critical thinking during the evaluation of the extracranial vessels. It requires a systematic approach and a thorough knowledge of hemodynamics, anatomic variations, and pathologic disease processes. Color Doppler is a invaluable tool used for accurate and decisive evaluation of abnormal hemodynamics.