bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal Vein and Inferior Vena Cava Tumor Thrombus: Presentation and Mapping of Venous Extension with Color Duplex Ultrasound
Authors: Sorrell Kathryn , Harris Shelley , Hanna Judy , Oglesby Beverly 
Published: March 2018

Introduction Renal cell carcinoma (RCC) has a unique tendency toward intravascular growth into the renal vein (RV), inferior vena cava (IVC), or even into the heart. To determine the operative approach and degree of surgical resection required, an accurate preoperative assessment of the extent of the tumor thrombus (TT) is mandatory. The purpose of this report is to describe the presentation of TT with color duplex ultrasound (CDU) and to report our initial experience in mapping the extent of vascular invasion in five patients. Methods Between January and November 2004, 5 patients with suspected RCC underwent a renal CDU examination. The presence and extent of TT by CDU was correlated with contrast enhanced computerized tomography (CT), magnetic resonance imaging (MRI) or surgical findings. Results Three men and two women were found to have a unilateral renal mass. The arterial supply to each tumor was conspicuous and consisted of prominent feeding arteries by color or power Doppler that circumscribed and penetrated the mass. TT was localized to the RV in one case and involved the RV and IVC in four. For two patients, the growth of TT into the IVC was limited and nonocclusive whereas in two others it was extensive and occlusive. In one case, TT invaded the IVC and the contralateral RV. By gray-scale imaging, TT appeared as an echogenic, heterogeneous mass that caused focal dilatation of the vein followed by rapid tapering. Interestingly, in three patients, low-resistance pulsatile flow could be recorded within the TT tissue itself. When compared with computed tomography, magnetic resonance imaging, or the operative findings, CDU agreed with the location and extent of TT in all 5 cases. Conclusion CDU appears to be an accurate technique for mapping the extent of TT in patients with RCC. Although this series is small, the unique gray scale and spectral Doppler characteristics of TT noted on CDU may be beneficial in distinguishing bland thrombus from TT.
The Role of Pre and Postprocedural Color Duplex Ultrasound for the Treatment of Lower Limb Ischemia by Subintimal Angioplasty
Authors: Kidd Jenifer , Bourke Bernard M. , Dunwoodie John , Lyons John 
Published: March 2018

Introduction Subintimal angioplasty (SIA) is the endovascular recanalization of vessels in the subintimal plane and most often is used to treat long-segment occlusions involving the femoropopliteal segment. This study demonstrates the value of pre- and postprocedural color duplex ultrasound (CDU) imaging. Methods Forty-three subintimal angioplasty procedures were performed to treat lower-extremity arterial occlusions. CDU was used as the definitive imaging modality in all cases. There were 26 women and 17 men, with a mean age of 76 years. Sixteen patients had anklebrachial index < 0.45. Most patients had significant medical comorbidities, placing them at high risk for arterial bypass procedures. Results In all patients, the extent of the occlusion was accurately diagnosed with CDU before intervention. SIA was technically successful in 42 of 43 patients (98%). The postprocedure CDU follow-up (1–2 months) demonstrated 10 patients had reoccluded (24%). Our primary patency rate was 42% at 30 months. Conclusion SIA can be an effective method of treatment in aged, high-risk patients with lower-extremity ischemia and threatened limb loss. CDU accurately locates the site of and measures the length of arterial occlusions in such patients, allowing the interventionalist to plan the site of arterial puncture and to prognosticate the likely success. CDU obviates the need for diagnostic angiography and remains the modality of choice for surveillance after SIA intervention.
Continuous Ultrasound Contrast Infusion as an Adjunct to Color Duplex Ultrasound in the Assessment of Aortic Endografts
Authors: Hodge Megan , Parker Daniel , Collado Esther , Broadbent Karen , Lumsden Alan B. , McCollum Charles H. , Noon George P. , Bush Ruth L. 
Published: March 2018

Objective —We sought to evaluate continuous ultrasound contrast infusion Optison® as an adjunct to color duplex ultrasound (CDU) in endoleak detection. Methods —Endoleak surveillance, including CDU, Optison®, and computed tomography (CTA), was performed during 18 examinations. One (3 ml) vial of Optison® was diluted in a 57-ml syringe of normal saline (total 60 ml) and administered by infusion pump at 4 ml/hr. Transverse and sagittal views were performed of the aortic aneurysm sac, endograft, and arteries outside the aneurysm sac. Primary endpoints were endograft patency, the presence or absence of endoleak, and limb dysfunction. Results —There were no adverse events related to the contrast agent. Contrast appearance through the endograft occurred after an average of 1 min using a mean of 46.8 ml of contrast infusion per patient. There were 10 enodleaks clearly identified by CDU and Optison®, i.e., 2 type I, 4 type II, and 2 type III endoleaks with an additional study suspicious for endoleak. Using CDU and CTA, we found 9 studies without endoleaks whereas with Optison®, we found 8 studies normal. Comparatively, when using CTA, we identified only 2 definitive endoleaks. Of the 9 endoleaks identified by using CDU and Optison®, 2 of the endoleaks were type I and not observed on conventional CTA and were later confirmed by arteriogram. One study was deemed negative by CDU and Optison® whereas CTA results were suspicious. Body habitus was prohibitive for definitive CDU findings in one patient. Conclusions —Using continuous ultrasound contrast infusion as an adjunct to CDU allowed for longer imaging time and more extensive evaluation of the endograft, the aneurysm sac, and the perianeurysmal arteries in these patients. Our early results demonstrate that the use of ultrasound contrast for endoleak detection is reliable and may be considered a primary surveillance modality after endovascular aortic aneurysm repair.
Duplex Ultrasound Surveillance after Axillofemoral Bypass
Authors: Stone Patrick A. , Armstrong Paul A. , Flaherty Sarah K. , Brumberg Robert , Back Martin R. , Weir Sheryl A. , Flasher Jacqueline T. , Kendrick Mary , Bandyk Dennis F. 
Published: March 2018

Objective —There are limited data available in the literature on duplex imaging after axillofemoral bypass grafting. We sought to explore this topic and identify duplex findings predictive of graft failure. Methods —All patients who underwent axillo-femoral or bifemoral prosthetic bypass procedures during an 9-year period and returned for follow-up duplex ultrasound scans (U/S) were included. Protocol based testing included ankle brachial indices, toe pressures, and duplex velocities at proximal anastomosis, mid-axillary graft, and femoral anastomosis sites. Results —Forty-seven patients underwent axillo-femoral bypass prosthetic procedures and returned for follow-up U/S. Mean follow-up was 61 ± 180 months (range, 1–1232) with a mean number of postoperative U/S of 4.5 per person ± 3.6 (range, 1–16). Eight bypass grafts (17%) occluded, i.e., 4 ax-bifemoral segments and 4 femoral-femoral segments. Two of eight occluded patients had not returned for postoperative U/S until occlusion occurred. Of the other 6 patients who underwent postoperative U/S before occlusion, all but one had midgraft peak systolic velocities of <85 cm/sec. Considering all patients evaluated with at least one postoperative examination, midgraft axillary femoral bypass velocities were predictive of future graft failure ( p = 0.0001) with occlusion occurring in 66% (5 of 8) of those with velocities <85 cm/sec, and 1 patient (1/37) with velocities >85 cm/sec. Two patients had velocities <85 cm/sec and remained patent. Six patients had abnormal studies (peak systolic velocities >250 cm/sec) but that did not progress to failure at follow-up. One patient had a para-anasatamotic aneurysm that was identified during follow-up that was treated by endovascular grafting. Conclusion —Midgraft axillary femoral bypass velocities are predictive of future graft failure.
What are the Duplex Ultrasound signs that Characterize an “Unstable Abdominal Aortic Aneurysm Sac” after Endograft Implantation?
Authors: Busch Kathryn , Kidd Jenifer , White Geoffrey , Harris John , Kelly Alison 
Published: March 2018

Introduction Classification of endoleak is determined by the mechanism by which the endograft fails to exclude the aneurysm. In some instances, the endoleak may be very subtle or not visible; yet, the aneurysm continues to expand. This report presents our experience in identifying unstable abdominal aortic aneurysm sacs associated with endoleaks or endotension in early and late monitoring using color duplex ultrasound (CDU) in a series of more than 1000 endograft patients. Aims We sought to (1) describe ultrasound features of atypical endoleaks and endoleaks from unusual sources and (2) characterize other CDU features that may be associated with endotension. Methods Philips HDI 5000 and IU22 machines were used during routine post-endograft surveillance scans of the abdominal aorta. Color, spectral, and power Doppler analysis were also performed to identify evidence of perigraft flow, graft stenosis, thrombus, kink, or migration. Secondary diagnostic maneuvers were conducted in the presence of perigraft flow to characterize the type of endoleak. Particular attention was also paid to the abdominal aortic aneurysm sac contents, size, and pulsatility. Correlation was made to angiography and computed tomography imaging in a series of 22 patients who underwent secondary endograft procedures or open conversion. Results Technically satisfactory studies were achieved in approximately 90% of patients. We detected type II endoleaks in 10% of patients assessed and graft migration in 12 cases. Endotension was characterized by sac enlargement and/or shape change without identifiable perigraft flow and correlated highly with device migration. Suggestive features of graft/sac instability included increased sac pulsatility, prominent areas of echolucency within the sac, and occasional low-amplitude atypical color signals within the sac thrombus close to the graft wall. Conclusion Reliable CDU assessment for late endograft follow-up requires careful scrutiny of the aneurysm sac contents and wall, as well as the graft device. Endoleak may not always be obvious yet CDU features can assist in identifying the source of endoleak or the presence of endotension. There are suspicious ultrasound features that may alert one to graft/sac instability and potentially dangerous outcome.
Fishing for BASS: Surveying Primary Physicians in the Barriers to Aortic Screening Study
Authors: Dueck Andrew D. , Wooster Elizabeth M. , Wooster Douglas L. 
Published: March 2018

Introduction In response to published guidelines for abdominal aortic aneurysm (AAA) screening, primary care physicians were surveyed to determine attitudes and identify barriers to screening. Methods Six hundred standardized, structured surveys were distributed to all primary care practitioners in a defined geographic area. Participation was voluntary, and results were anonymous. Results A total of 10.7% of surveys were returned. All questions were answered by >93% of respondents. A total of 71.9% of respondents were general practitioners; 94.4% worked in a community setting. 60.9% saw >11 male patients per week who were older than 65 years of age. Responses indicated support for identifying asymptomatic AAAs; only 4.7% thought their patients were too sick to undergo repair, 0% felt their patients would be unwilling to undergo repair, and 0% felt the risk of rupture was too small to justify repair. Access to vascular surgical services was available to more than 75% in the hospital closest to them, and to 100% in the city in which they practice. A total of 42.2% were aware of recommendations regarding AAA screening, and 65.6% of physicians routinely screened eligible patients for AAAs. Screening for other diseases was more frequent. Respondents routinely screened their patients for breast cancer (79.1%), prostate cancer (80.5%), colon cancer (80.9%), and hypertension (83.7%); 42.9% routinely screened for peripheral artery disease. Conclusion Screening for AAAs lags significantly behind other major screening programs. Although primary practitioners are routinely exposed to the target population, a minority of patients are screened. Neither access to a vascular surgeon nor knowledge about the importance of AAAs appears to be limiting factors. Despite recent publicity, almost 60% of primary care physicians remain unaware of screening guidelines for AAAs. Of those who were aware of guidelines, only one third follow them. Further research and education is required to increase the efficacy of screening.
Common Carotid Intimal-medial Thickness is associated with Coronary In-Stent Restenosis
Authors: Jones Gregory T. , van Rij A. M. , Hill G. B. , Wilkins G. T. , Williams M. J. A. 
Published: March 2018

Introduction Coronary artery in-stent restenosis (ISR) consists of a rapid vascular smooth muscle cell proliferation after stent placement. This study tested the hypothesis that carotid artery intimal thickening may be associated with susceptibility to coronary ISR. Methods Coronary stent treated patients with (ISR, n = 81) and without (ISR-free, n = 163) ISR were examined along with age- and gender-matched vascular disease-free controls (n = 200). All participants underwent bilateral carotid duplex ultrasound assessment and cardiovascular risk factor evaluation. Multiple logistic regressions were used to determine the independence of any risk associations with either coronary artery disease or ISR. Results Maximal carotid intimal medial thickness was independently associated with symptomatic coronary ISR, with an adjusted odds ratio of 3.4 (95% confidence interval, 1.5–7.7, p < 0.005 for carotid intimal medial thickness >1 mm). Atherosclerosis within the carotid bifurcation and internal carotid artery, as measured by carotid stenosis scores, was significantly greater in both coronary artery patient groups compared with vascular disease-free controls but was not associated with ISR. Conclusions Intimal thickening within the common carotid artery may represent a distinct pathological process from that which occurs within the carotid bifurcation and internal carotid arteries. Changes in common carotid IMT appears to represent an independent risk indicator for symptomatic coronary ISR.
Age, Race, and Gender Influence Internal Carotid Artery Doppler Velocities in Children
Authors: McCoy Connie E. , Urbina Elaine M. , Khoury Philip R. , Kimball Thomas R. 
Published: March 2018

Introduction Few data are available describing internal carotid artery pulsed-wave Doppler velocities in children. Therefore, mean values were obtained in healthy children and correlates of peak systolic (PSV) and end diastolic (EDV) velocities were determinants. Methods As part of an ongoing longitudinal study of cardiovascular risk factors in children, bilateral PSV and EDV were obtained in 115 subjects (age 17.0 ± 3.8 years; 37% Caucasian, 63% African American; 43% male, 57% female). Standard carotid duplex imaging was performed with a GE Vivid 7, 7–12 MHz linear array transducer. Velocities were acquired in the proximal 2 cm of each artery, placing the angle of insonation parallel to vessel wall resulting in angles of ≥50 degrees and ≤60 degrees. All velocities were measured in triplicate. Means and standard deviations of all significant variables were calculated and differences tested with t-testing. Pearson correlation coefficients between PSV, EDV, and covariates (age < or ≥ 18 years, height (HT), weight (WT), gender, systolic blood pressure) were determined. General linear models were constructed to elucidate significant determinants of velocities. Results Mean values for PSV and EDV differed significantly by age and race. PSV values differed by gender (all p < 0.02). Age and race correlated with PSV and EDV, whereas gender correlated only with PSV measures. In general linear models, when stratified by age groups, age and race were significant determinates of both velocities and HT only a determinate for PSV. Younger subjects had greater velocities. When stratified by race, results were similar, with Caucasians having increased velocities. When stratified by gender, no models were significant. Conclusion Normal PSV and EDV values are greater in children than adults and in Caucasians versus African-Americans. These may be influenced by age and race differences in HT. Proximal internal carotid pulsed Doppler velocities in children should be interpreted based by age and race.
Case Study: Large Hepatic Artery Aneurysm and a Review of the Literature
Authors: Rezac Jennifer 
Published: March 2018

Introduction Hepatic artery aneurysm is a rare and life-threatening lesion. Patients with hepatic artery aneurysm are often asymptomatic, which makes diagnosis difficult. Early diagnosis is essential because of the high risk of rupture. The following case describes an incidental finding of a large hepatic artery aneurysm. Methods A 74-year-old woman presented to the vascular lab for a renal artery evaluation. The patient had hypertension and chronic renal failure with elevated blood urea nitrogen and creatinine. Evaluation of the abdominal aorta was also requested because of a palpable, pulsatile abdominal mass and abdominal bruit. The patient additionally stated epigastric and right upper quadrant pain for the previous 6 months. Results The renal arteries displayed normal flow velocities without evidence of stenosis. Bilateral kidneys did exhibit parenchymal disease. Examination of the abdominal aorta demonstrated an infrarenal abdominal aortic aneurysm measuring 6.4 cm. In the proximal abdomen, at the level of the patient's pain, a large 11-cm aneurysm was identified. because of the large size of the aneurysm causing displacement of the vasculature, the artery of origin was not positively identified. To further delineate this lesion, the patient underwent computed tomography and angiography; however, these were also unsuccessful. The patient was eventually brought to the operating room for surgical repair of this aneurysm as well as her infrarenal AAA. Intraoperatively, the aneurysm was found to be originating from the hepatic artery. Conclusion Although a rare finding, hepatic artery aneurysm can be identified and evaluated with ultrasound. Additional testing with computed tomography and angiography helps to define the arterial source and location of the aneurysm, as well as collateral flow to the liver if the hepatic artery is compromised. Once identified, these lesions need to be surgically or interventionally treated due to their high mortality rate.
Duplex-Guided Angioplasty of Failing or Nonmaturing Arteriovenous Access
Authors: Marks Natalie , Hingorani Anil , Ascher Enrico 
Published: March 2018

Objective Patients not yet on dialysis with nonmaturing arterio-venous (AV) accesses present a therapeutic problem. Because the standard treatment with balloon angioplasty requires nephrotoxic contrast use for diagnosis and treatment, we have sought an alternative therapy. Methods Five consecutive patients with chronic renal insufficiency and failing arteriovenous (AV) access underwent duplex-guided balloon angioplasties at our institution. These were 3 women and 2 men with age ranging from 70 to 85 years (mean 77 ± 7 years). All patients were hypertensive, 4 (80%) were diabetics, and 3 (60%) had coronary artery disease. Three patients (60%) had target AV access used for dialysis. Preoperative volume flows (VF) measured by duplex ranged from 200 mL/min to 1160 mL/min (mean 755 ± 358 mL/min). Peal systolic velocity obtained at the most significant stenosis preoperatively ranged from 428 cm/sec to 656 cm/sec (mean 555 ± 87 cm/sec). Technique All procedures were performed via short sheath inserted under duplex guidance. Wire and balloon passage and inflation were performed under duplex surveillance as well. Results None of these procedures required use of fluoroscopy or contrast material. One patient had a stent placed for recoiling lesion. Postoperative VF ranged from 520 mL/min to 1750 mL/min (mean 1272 ± 486 mL/min). Peal systolic velocity obtained at the most significant stenosis postoperatively ranged from 142 cm/sec to 321 cm/sec (mean 233 ± 64 cm/sec). Conclusions Angioplasty of failing AV access can be performed under duplex guidance alone. Duplex guidance offers advantages of hemodynamic evaluation for recoiling lesions and need for stenting.
Duplex-Derived Maximum Venous Outflow Velocity (MVOV) of the Common Femoral Veins is Asymmetric in Normal Women
Authors: Lebow Michael , Edmondson James , Nagarsheth Khanjan , Cassada David , Currie Kate , Goldman Mitchell 
Published: March 2018

Background It is generally accepted that a significant portion of our population harbors asymptomatic compression of the left iliac vein by the right iliac artery. This was demonstrated originally in autopsy studies by McMurrich in 1908 (33% of 107 cadavers) and more recently by the analysis of Contrast CT scans 1 (66% of 50 patients). Authors have found that Venography may lack the sensitivity to be considered a true “gold standard” (66% sensitive) while IVUS is over 90% sensitive 2. No studies have addressed the physiologic difference in flow hemodynamics between the left and right lower extremities in normal individuals. We use Doppler ultrasound to demonstrate asymmetric flow in the lower extremities of normal individuals. Methods Maximum venous outflow velocity (MVOV) in the Common femoral veins were recorded using Doppler ultrasound on 30 volunteers. Inclusion criteria included age 18–30, BMI <30, female sex and no history of venous disease or leg swelling. All studies were preformed by the same experienced vascular technologist. Volunteers were instructed to lay supine while a blood pressure cuff was inflated to 100 mmhg around the mid-thigh. Presence of arterial flow was confirmed with color duplex after cuff inflation. Prior to rapid cuff release at 1 minute patients were instructed to exhale and hold their breath to augment venous outflow. Flow velocities in the left and right common femoral veins were recorded. Results The average age was 20.9 years (range 19–28 years) and the average BMI was 21.9 (range, 18–25). MVOV was slower on the left side in 22, slower on the right in 7 and equal in one volunteer. The mean right MVOV was 117.23 cm/sec, SD 46.95 and the mean left MVOV was 95.44 cm/sec, SD 32.94 ( P = 0.0095). There was no correlation between left and right MVOV with respect to age, BMI or height. Conclusions Significant differences in lower extremity venous flow are present in normal individuals at rest. This finding correlates with anatomic studies demonstrating a predilection towards narrowing of the left iliac vein in normal subjects. This simple, non-invasive method of quantifying venous hemodynamics may aid in selecting patients for further diagnostic testing or intervention.