bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre- and Postprocedure Duplex Evaluation of Distal Revascularization-Interval Ligation Procedure: A Case Study
Authors: Scarola Lisa , Eliassi Lois , Rodriguez-Wong Angela , Porreca Francis J. 
Published: March 2018

Introduction Duplex ultrasound is a valuable modality for the assessment of hemodialysis access function. A potential complication of hemodialysis access is arterial steal, which occurs when venous outflow exceeds the capacity of the inflow artery, and flow in this distal artery becomes retrograde, stealing blood flow from the hand to the fistula site. A potential condition resulting from arterial steal is hand or digit ischemia. Distal revascularization-interval ligation (DRIL) procedures can be used to “bypass” the fistula or graft site and deliver blood to the hypoperfused hand. Presented is a case of an arterial steal with severe hand ischemia that was alleviated by a DRIL procedure. Case Study A 69-year-old woman presented to the vascular laboratory with an ischemic right hand and digital ulcer distal to a brachial-axillary arteriovenous graft (AVG). Duplex ultrasound was performed of the right upper-extremity inflow arteries, AVG, and outflow veins. Ipsilateral brachial, radial, and ulnar artery waveform analysis for direction of flow was performed with and without AVG compression. The evaluation revealed significant arterial ischemia that returned to normal after manual compression of the AVG. The patient underwent a DRIL procedure after the pre-op duplex evaluation. Postprocedural duplex evaluation revealed patent inflow and outflow vessels, patent graft, and bypass (DRIL) with antegrade flow in the brachial and radial arteries and no change of flow with manual graft compression; clinically, the patient had a healing ulceration of the digit. Conclusion Duplex ultrasound for hemodialysis access should not only be used to evaluate for patency of the fistula or graft but should include assessment for ischemia and/or steal. This case demonstrates the importance of the assessment of the distal arterial segments including digital waveforms, and the use of manual compression to complete the hemodialysis access evaluation. DRIL procedures can potentially correct arterial steal while preserving access function.
Schwannoma of the Posterior Tibial Nerve: An Unusual Finding during Arterial Ultrasound Examination of the Lower Extremities
Authors: Maia Miguel , Riobom Filipe , Ferreira Joana , Braga Sandrina , Vasconcelos João , Brandão Pedro , Vaz Guedes 
Published: March 2018

Introduction Ultrasound examination of the lower extremity, regardless of the motive, can yield a considerable amount of data essential to the diagnosis of various diseases. Case Report We reported a clinical case of a woman, 50 years of age, who was sent to our vascular laboratory for arterial ultrasound examination of the lower extremities. She complained of coldness of the left foot associated with paresthesia and hypersensitivity of the middle third of the left lower leg for the past 3 years. During physical examination, there was a diminished, but palpable, posterior tibial artery pulse. The ultrasound performed revealed a tumor of the posterior tibial nerve, with 4 cm in longitudinal dimension and 2.7 cm of maximum diameter, typical of a neurofibroma or a schwannoma, with anterior deviation of the vascular structures. She was referred to a plastic surgeon and submitted to surgical resection of the nerve sheath tumor, with preservation of artery and venous flow. Histological analysis revealed a capsulated mass with fusiform cells, without atypical cells, compatible with a schwannoma. Patient completed 1 year of follow-up, maintaining a slight, nondisabling, local hypersensitivity. Discussion This clinical case shows an interesting imaging finding, with major repercussions in the treatment of this patient.
A Case of Mistaken Identity: When a Deep Vein Thrombosis is not a Thrombosis
Authors: Hamilton Debbie , Omari Abdullah 
Published: March 2018

Introduction Although rare, nonthrombotic causes of venous obstruction do occur. Their ultrasound findings can mimic deep vein thrombosis (DVT). We sought to examine the ultrasound appearance of these tumors to determine whether their differentiation from DVT was possible. Case Report Two patients, in whom a DVT was initially suspected, were subsequently diagnosed with intravascular tumors: a leiomyosarcoma and a hemangioma. The first patient presented with thigh pain, and an initial diagnosis of long saphenous vein (LSV) and common femoral vein thrombosis was made. The apparent thrombus remained unchanged despite anticoagulation. Proliferation of the lesion outside of the LSV developed, resulting in a review of the diagnosis, and surgical resection was performed. A histological diagnosis of leiomyosarcoma was made. The second patient presented with leg swelling and an initial diagnosis of External Iliac vein thrombosis was made. Further ultrasound assessments demonstrated arterialized flow within the lesion and surgical resection was performed, with a histological diagnosis of intravascular epithelioid hemangioma. Results The B-mode appearance was similar for both. The presence of arterialized flow within the lesions is helpful but may not be diagnostic because of recent reports that neovascularization may develop within thrombus. Conclusion Suspicion needs to be raised in a patient presenting with an unprovoked DVT or when conventional treatment does not result in improvement of symptoms; as well as when prolonged arterialization is identified within the thrombus. These signs can alert the clinician to a possible non-thrombotic mechanism of venous obstruction.
Evaluation of Carotid Wall Thickness by using Computed Tomography and Semiautomated Ultrasonographic Software
Authors: Saba Luca , Sanfilippo Roberto , Tallapally Niranjan , Molinari Filippo , Montisci Roberto , Mallarini Giorgio , Suri Jasjit S. 
Published: March 2018

Purpose The increased thickness of the carotid artery is associated with the development of coronary and cerebrovascular events. In this study our purpose was to evaluate the carotid artery wall thickness (CAWT) by using multidetector-row computed tomography angiography (MDCTA) and the intima media thickness (IMT) by using semiautomated ultrasonography (SA-US) to evaluate the agreement between the two methods. Methods This is a retrospective study, and the institutional review board approval was obtained. Twenty-one patients (age range, 59–81 years) were analyzed with the use of a 16-detector row CT and a sonographic scanner. In total, 14 subjects had shown cerebral ischemic symptoms. The IMT was quantified by the use of specific semiautomated software (ImgTracer™, Global Biomedical Technologies, Roseville, CA) by four expert observers, and the CAWT was measured by use of the MDCTA. Data were compared with the Wilcoxon test for paired samples. Bland–Altman statistics was used to measure the agreement between MDCTA and SA-US. A p value < 0.05 was considered significant. Results Forty-two carotids were analyzed, and the CAWT ranged from 0.64 to 2.99 mm, with a mean value of 1.438 mm. By analyzing the Bland–Altman plots, we observed a good agreement between SA-US and correlation coefficient r were 0.9250 (95% confidence interval [CI] 0.864–0.959; p < 0.0001), 0.9265 (95% CI 0.866–0.961; p < 0.0001), 0.9466 (95% CI 0.902–0.971; p < 0.0001), and 0.8621 (95% CI: 0.756–0.924; p < 0.0001) for observer 1, observer 2, observer 3 and observer 4 respectively. Conclusions Data of this preliminary study by using SA-US and MDCTA demonstrated a good agreement between in the measurement of CAWT and IMT.
Is Preoperative Vein Mapping Beneficial for the Creation of Dialysis Arteriovenous Fistulas?
Authors: Croft Renee , Brooks Sara , Nicolaou Angela , Kakkos Stavros , Kennedy Nicole , Haddad Georges , Lin Judith 
Published: March 2018

Introduction The use of preoperative vein mapping for arteriovenous fistula creation has shown promise in multiple studies over the years. However, a definitive scanning technique has not been well described. Our center has developed a standard method of preoperative vein mapping performed by a select group of trained technologists. Together with a single surgeon, we believe that this technique is equivalent to if not better than previously described methods. Methods In a retrospective study of 88 patients, all patients underwent preoperative scanning according to our dialysis mapping protocol with subsequent operative intervention. Results Eighty-three of the 88 patients mapped correctly matched the surgeon's findings. Seventy-five patients had successful fistula creation. Sixty-one patients (82%) who had fistulas placed were accurately predicted by their preoperative mapping. Of the 83 patients, 94% presented for a 2-week follow-up appointment. At this point, 81% of fistulas showed evidence of a good thrill and were developing at a sufficient rate. In addition, 89% of these patients presented for a long-term follow-up appointment at 60 days postoperatively. Approximately 6.7% of these patients required additional intervention to progress fistula maturation at this point. Conclusion Further prospective studies with additional centers to use as control groups would be helpful in evaluating this technique. However, this scanning protocol shows promise as a method of obtaining favorable results in a consistent fashion.
Isolated Superficial Femoral Artery Aneurysm: A Case Study
Authors: Wise Matthew , Klein Daren , Gibson Kathleen D. 
Published: March 2018

Introduction Isolated aneurysms of the superficial femoral artery (SFA) are rare, and their etiology is not yet fully understood. Although not as common as abdominal aortic or popliteal artery aneurysms, they pose a serious threat of rupture and/or thrombosis. Because of their atypical presentation, they can be easily misdiagnosed. Methods A 58-year-old man presented with a painful lump over his left medial thigh, first noted 6 months previously. The patient was asymptomatic in regards to claudication. The findings of magnetic resonance imaging suggested a vascular mass versus pseudoaneurysm of the SFA. The patient was referred to the vascular laboratory and underwent duplex evaluation. This revealed an 8.3–cm long SFA aneurysm with a maximum diameter of 5.9 cm with extensive mural thrombus present. Angiography confirmed a true aneurysm, with an estimated length of 5 cm and luminal diameter of 2.5 cm. Result The patient underwent open aneurysmorrhaphy with a femoral to popliteal reverse saphenous vein bypass graft. Upon direct visualization, the aneurysm was estimated to measure 8 cm length and 6 cm in diameter. The patient recovered without incident and has normal ankle brachial indices. Conclusion True isolated aneurysms in the SFA are rare, and the exact cause is not yet known. Proper diagnosis and identification are crucial to patient outcome. In our case, duplex ultrasound yielded a more accurate measurement of the true aneurysm size when compared with the angiogram. This is attributable to the angiogram measuring the flow channel of the residual lumen while not visualizing the thrombus filled sac. Endovascular stent grafts or open repair with bypass grafts (vein or prosthetic) are the accepted methods of treatment with good patient outcome. Allowed to progress untreated, these aneurysms often rupture or thrombose, which can ultimately lead to limb loss. Because of the increased incidence of aneurysmal disease elsewhere in the body, these patients should undergo additional screening.
Incidental Findings of Tumors in a Routine Venous Duplex
Authors: Young Laurie 
Published: March 2018

Introduction Deep venous thrombosis (DVT) is a condition routinely evaluated for in a vascular laboratory on a daily basis. Patients usually present with symptoms of peripheral pain, swelling, shortness of breath, or chest pain. Pain and swelling are not symptoms unique to DVT, however, and an ultrasound test could potentially serve as a basis for incidental findings that would serve as an underlying reason for the patient's symptoms. It is important to recognize the role in evaluating flow characteristics and using appropriate methods for identifying deep veins to exclude, or include, DVT as a cause for symptoms. Case Reports Two case studies are presented here in light of excluding DVT and identifying tumors. The first patient presented to the emergency department with left upper extremity swelling and pain. A left upper-extremity venous ultrasound was performed to discover all veins were fully compressible. No intraluminal thrombus was noted, yet all veins demonstrated abnormal, continuous flow. A significant proximal venous obstruction was indicated at the level of the left clavicle by ultrasound based on the observed abnormal flow. A chest X-ray and computed tomography was ordered, and the presence of a large Pancoast tumor was discovered. It extended superiorly from the left lung towards the clavicle, extrinsically compressing the proximal left subclavian vein. The patient subsequently had concurrent chemotherapy and radiation therapy treatment and rehabilitation. The second patient presented with a mild fever and tachycardia and was status postcervical tumor surgery. The ultrasound revealed multiple segments of homogenously echogenic, Doppler-silent, incompressible structures visualized adjacent to the deep vasculature system throughout bilateral lower extremities. These structures could easily be mistaken for DVT as they appeared similar in B-mode character. Clear identification of venous flow demonstrated around these structures differentiated the veins, and the contiguous visualization of the vein lumen, from these structures. These structures were diagnosed as Schwannoma, tumors consisting only of Schwann cells, that run along the nerves, which in turn run along the deep vasculature.
Ultrasound-Guided Transcatheter Ethanol Injection and Sclerotherapy of an Arteriovenous Malformation of the Foot
Authors: Seckora Makenzie M. , Pizzo Del David J. , Link Daniel P. 
Published: March 2018

Introduction Arteriovenous malformations (AVMs) are abnormal, direct connections between the arteries and veins. AVMs are most commonly associated with the brain and spinal cord; however, they can occur in any part of the body. Duplex ultrasound can play a pivotal role in both the diagnosis and treatment of AVMs. Methods A high-resolution duplex ultrasound machine along with a high-frequency 15–7 MHz probe was used in transcatheter techniques to treat an AVM. Ultrasound was used to guide arterial and venous access, target specific vessels for treatment, and ultimately reduce radiation exposure. Case Report A 6-year-old female patient was diagnosed with a left foot AVM and hemihypertrophy (Parkes Weber). Despite previous treatments with coil embolization, the patient developed discoloration and swelling of the left second toe and a nonhealing ulceration on the plantar aspect of the left foot. Duplex ultrasound was used to confirm the diagnosis and to aid in the treatment of the AVM. Under ultrasound guidance, catheter access was achieved via the dorsalis pedis artery and advanced distally into a large digital artery directly associated with the AVM. Anhydrous ethanol alcohol was injected through the catheter to treat the arterial inflow of the AVM. Ultrasound was then used to identify cavernous veins on the plantar aspect of the foot and to guide direct ethanol injections into the affected veins. Two weeks after the procedure, ultrasound confirmed 90% reduction in the AVM. The patient's toe discoloration resolved, and the ulceration healed. Conclusion Undiagnosed or poorly managed AVMs of the extremities can result in multiple surgical resections and skin deterioration. Ultrasound imaging of arteriovenous malformations with B-mode, color, and Doppler is essential for the evaluation (staging), treatment, and follow-up of vascular malformations. Ultrasound-guided transcatheter and direct techniques can be used in the treatment and prolonged management of AVMs. The application of ultrasound during these treatments will reduce radiation exposure in these patients.
The Postexercise Common Femoral Artery Doppler Waveform: A Powerful Noninvasive Vascular Laboratory Test to Exclude Aortoiliac Disease
Authors: Kalish Jeffrey , Nguyen Tony , Hamburg Naomi , Eberhardt Robert , Farber Alik 
Published: March 2018

Objective The detection of aortoiliac occlusive disease (AIOD) has important clinical implications for patients with peripheral arterial disease. The clinical utility of the common femoral artery (CFA) Doppler waveform (DW) at rest and after exercise in the detection of AIOD was investigated. Methods A retrospective review was performed of 203 consecutive exercise treadmill tests at Boston Medical Center from January 2006 to July 2009 that included both resting and postexercise CFA DW. The study population consisted of 62 patients (124 limbs) who had additional anatomical imaging studies, including computed tomography, magnetic resonance, or conventional angiography. Two blinded observers reviewed the CFA DW and imaging studies. Triphasic or biphasic CFA DW were considered normal. Monophasic CFA DW was considered abnormal. To determine test characteristics, resting and postexercise CFA DW were compared with the imaging findings. Similar analysis was performed for the ankle brachial index (ABI) for comparison. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (with 95% confidence interval) of the resting CFA DW in detecting a >50% aortoiliac stenosis were 29% (21–37%), 92% (87–97%), 31% (23–39%), 91% (86–96%), and 85% (79–91%), respectively. The results for the postexercise CFA DW in detecting a >50% aortoiliac stenosis were 93% (89–97%), 59% (50–68%), 22% (15–29%), 99% (97–100%), and 63% (55–71%), respectively. Resting CFA DW detected only 4 of 14 limbs with AIOD. Postexercise CFA DW markedly increased the detection of AIOD: 9 limbs with normal resting CFA DW were correctly diagnosed on the basis of postexercise CFA DW for a total of 13 of 14 limbs with AIOD. In addition, postexercise change in ABI was analyzed and only detected 9 of the 14 limbs with AIOD. Conclusions These findings support the use of postexercise CFA DW to enhance the evaluation of clinically important AIOD. The sensitivity of the test to detect AIOD was improved compared with resting CFA DW or postexercise drop in ABI. Normal postexercise CFA DW has high predictive value in excluding significant inflow disease.
Duplex Ultrasound Findings in Intravenous Drug Users with Femoral Vein Injection
Authors: Smith Watson B. , Campbell Kari A. , Zierler R. Eugene 
Published: March 2018

Introduction —Intravenous drug users (IVDUs) who access their common femoral vein (CFV) repetitively are at risk for a variety of vascular complications. Duplex ultrasound is often the initial imaging modality used when these patients present for medical care. The purpose of this study was to document the duplex ultrasound findings and associated clinical outcomes in IVDU with CFV injection. Methods —This was an institutional review board-approved retrospective review of all lower-extremity duplex ultrasound examinations performed on IVDU in our laboratory from January 1, 2007 through December 31, 2009. Vascular laboratory reports and images were reviewed along with clinic and hospital records. Results —The study cohort included 29 patients, 52 lower limbs, and 102 duplex ultrasound examinations. There were 16 males and 13 females with an age range of 19 to 53 years (mean, 33 years). Follow-up intervals ranged from 0 to 24 months (mean, 11 months). The most common indication for duplex ultrasound was a swollen painful leg. Abnormalities were present on duplex ultrasound in 92% of the limbs. A CFV stricture was identified in 63% of the limbs and 44% had cystic masses associated with the proximal femoral vessels. Progression to DVT was observed in 45% of the CFV strictures. Arterial lesions were found in 21% of the limbs. One retained needle was identified. Venous or arterial interventions were required in 9 limbs. Conclusion —Femoral injection in IVDU results in a high prevalence of abnormal vascular findings on duplex ultrasound. Although venous lesions were more common, arterial and venous interventions were approximately equal in frequency. The IVDU patients also had a high prevalence of lower-limb DVT. The vascular laboratory can play an important role in the evaluation of IVDU with CFV injection. This review suggests that duplex ultrasound in these patients should include both a complete lower extremity venous examination and assessment of the iliac and femoral arteries.
Impact of Routine Use of a Tourniquet during Preoperative Vein Mapping on the Diameter of Arm Veins and Creation of Functional Arteriovenous Fistulas
Authors: Jayaraj Arjun , Crawford Courtney , Logar Christine , Hatsukami Thomas , Allen Brenda , Tran Nam 
Published: March 2018

Purpose —To examine the impact of tourniquet usage during preoperative vein mapping on diameter of arm veins and functionality of autogenous arteriovenous fistulas (AVF) thus created. Methods —A total of 160 patients in need of hemodialysis access underwent segmental upper-extremity duplex ultrasonography. Vein measurements were performed with and without application of an upper arm tourniquet. Criteria for AVF creation included superficial veins with diameter ≥3.0 mm and continuity with proximal superficial veins. Group I had patients with veins with diameter ≥3.0 mm attained without use of a tourniquet whereas Group II had patients with vein diameters ≥3.0 mm achieved with a tourniquet. Clinical outcomes were compared between the two groups. Results —Of the 160 patients, 114 underwent placement of an upper extremity AVF, whereas the remaining underwent placement of an AV graft or peritoneal dialysis catheter. Of these, 87 patients were in Group I and 27 in group II. The primary outcome was defined as a functional AVF within 6 months of surgery. In Group I, almost two of every three fistulas created were successful, resulting in a failure rate of 37.5%. In contrast, only one out of every six AVFs in Group II was successful resulting in a failure rate of 86%. Conclusion —The use of tourniquet results in a greater number of patients qualifying for AVF creation. However, AVFs created using vein diameter obtained from the application of a tourniquet have much greater rates of failure compared with AVFs created by using a vein of similar diameter but without a tourniquet.