bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis and Ultrasound-Guided Repair of an Iliac Artery Dissection
Authors: Cruz Joshua , Lipsitz Evan C. , Berdejo George L. 
Published: March 2018

Introduction Although contrast arteriography (CA) has historically been considered the gold standard for imaging of the lower extremity arteries, it has known limitations and complications. Duplex ultrasound (DU) imaging has emerged as a viable, and in some instances superior, alternative to CA. The following case study describes the use of DU to diagnose and treat an iliac artery dissection not appreciated by conventional multi-planar contrast arteriography. Case Report The patient is a 46-year-old man with a significant smoking history and symptomatic peripheral vascular disease who has undergone percutaneous transluminal coronary angioplasty and stent placement after a myocardial infarction. He presented with complaints of progressively worsening right leg claudication. The workup included a duplex arterial mapping performed prior to diagnostic CA. DU revealed a short segment right superficial femoral artery (SFA) occlusion and normal Doppler flow characteristics in the common femoral artery. Arteriography confirmed the presence of the SFA occlusion. A follow-up duplex to rule out a groin pseudoaneurysm was then performed. This study revealed no pseudoaneurysm but identified a dissection extending from the mid external iliac artery (EIA) to the distal common femoral artery that was not appreciated by CA. Because of the DU findings, intraoperative CA to evaluate the EIA was performed at the time of SFA endarterectomy and patch angioplasty. Again, the dissection was not evident, and as a result of the inconclusive arteriogram, ultrasound was used intraoperatively to image and facilitate its repair. A 9 × 40-mm SMART stent (Cordis®, Warren, NJ) was deployed in the EIA under ultrasound guidance to seal the leading edge of the dissection. Completion DU showed sealing of the origin of the dissection and near-complete elimination of flow in the false lumen. Conclusions DU diagnosed an EIA dissection that was not detected on CA and was subsequently used as the sole imaging modality to guide deployment of a stent for its repair. This case illustrates that duplex evaluation can be superior to arteriography for both the diagnosis and treatment of patients with peripheral arterial disease.
The Prevalence of Aorto-iliac Disease by Duplex Ultrasound in Patients with Suspected Lower Extremity Arterial Disease
Authors: Hughes Joseph P. , Dubin Rick , Bowman Gary R. , Cochran Terence A. 
Published: March 2018

Introduction Color duplex ultrasound (CDU) is used to document the location and severity of disease in the arterial system. The purpose of this study was to determine the prevalence, location, and severity of disease in the aorto-iliac arterial segment in patients with signs and symptoms of peripheral arterial disease and undergoing routine lower extremity arterial CDU evaluation. Methods The charts of 45 randomly selected patients with suspected lower extremity peripheral arterial disease (PAD) who were undergoing routine extremity arterial CDU testing were retrospectively reviewed. Disease processes of the aorto-iliac segment were grouped into four categories: ectatic aorta (EA), abdominal aortic aneurysm (AAA), non–hemodynamically significant plaque (NHSP), and hemodynamically significant plaque (HSP). Disease findings were based on internally validated CDU criteria. Findings were considered significant if the patient had AAA or HSP. Results Of the 45 records reviewed, 8 patients did not have an aorto-iliac evaluation based on testing protocols, and 11 were excluded for nonvisualization of the aorto-iliac segment due to bowel gas or body habitus. Of the 26 remaining patients, 4 patients presented with normal findings (15%), 14 with NHSP (54%), 8 with AAA (31%), 7 with HSP (27%), and 2 with EC of the aorta (8%). When grouped by significant findings, 4 patients presented with AAA and HSP (15%), 4 with AAA only (15%), and 3 with HSP (12%). Conclusion Findings of disease in the aorto-iliac segment were noted in 85% of the patients in this population. Significant disease was present in 42% of the patients in this population. Evaluation of the aorto-iliac segment with CDU in patients with suspected PAD appears to have a significant yield; however, further investigation with a larger patient population and a comparison to other testing modalities is necessary.
Validation of an Automated Computerized Analyzing System for Measuring Common Carotid Artery Intima–Media Thickness by Brightness Mode Ultrasound
Authors: Fritz Helmuth F. , Jutzy Roy V. , Bansal Ramesh , Housten-Feenstra Linda 
Published: March 2018

Background and Purpose Evaluation of subclinical atherosclerosis by B-mode carotid ultrasound intima–media thickness (IMT) is an endorsed technique whose ease and precision is improved by use of automated IMT measurement algorithms. We report results of a validation study of SonoCalc, an automated IMT software program. Methods Three vascular sonographers measured the mean common carotid artery IMT twice of 120 near and far wall CCA segments from 30 subjects by manual electronic instrument calipers and with SonoCalc. Results Accuracy analysis indicated the equivalence of SonoCalc IMT measurements to those with manual electronic instrument calipers ( p < 0.0001). The coefficient of variation (CV) was calculated for each set of duplicate SonoCalc and manual electronic instrument calipers measurements. The average SonoCalc-manual electronic instrument calipers CV differences significantly favored SonoCalc ( p < 0.0001). Conclusion This study demonstrated that the use of the SonoCalc and the manual electronic instrument calipers produced measurements whose differences were statistically insignificant. Furthermore, the analysis to assess reproducibility of the two methods showed that the SonoCalc method was significantly more reproducible than the manual electronic instrument calipers methods.
Carotid Artery Pseudoaneurysm after Endovascular Stent Placement: Diagnosis and Follow-up Duplex Ultrasonography
Authors: Zhou Wei , Bush Ruth L. , Lin Peter H. , Hodge Megan D. , Felkai Deborah D. , McCollum Charles H. , Noon George , Lumsden Alan B. 
Published: March 2018

Purpose Carotid artery pseudoaneurysm development after endarterectomy, albeit rare, has been attributed to patch deterioration. We present an unusual case of pseudoaneurysm development 1 year after stent placement for recurrent carotid artery stenosis. Case Report A 64-year-old man had transient hemiparesis develop 1 week after carotid artery endarterectomy (CEA) with patch angioplasty for monocular transient ischemic attack. Carotid angiography reviewed an intimal flap at the distal endarterectomy site, which was successfully treated with carotid stent placement. During a duplex scan 1 year later, he was found to have a symptomatic 2.5-cm pseudoaneurysm at the level of stented carotid bifurcation. This was successfully treated with a combined open and endovascular approach, which consisted of stent-graft placement by means of an open carotid exposure. Completion angiogram showed successful stent-graft exclusion of the pseudoaneurysm. A follow-up duplex scan 6 months later demonstrated diminution of pseudoaneurysm size without endoleak. Conclusion This report highlights the importance of duplex ultrasound surveillance in patients with CEA or carotid stenting, because it can accurately detect recurrent stenosis or carotid pseudoaneurysm. Moreover, a combined open and endovascular therapy using stent graft successfully treated the carotid pseudoaneurysm in our patient.
Selective use of Duplex Ultrasound after Successful Thrombin Injection of Pseudoaneurysms
Authors: Stone Patrick A. , AbuRahma Ali F. , Hayes J. David , Flaherty Sarah K. , Elmore Michael S. , Lohan James A. 
Published: March 2018

Introduction Duplex-guided thrombin injection (DGTI) has been shown to be a safe and efficacious initial treatment of iatrogenic arterial pseudoaneurysms. Postinjection follow-up duplex ultrasound examination has become the accepted standard of care despite 1) the use of intraprocedural ultrasonography to monitor successful thrombosis, 2) a low post-DGTI recurrence rate, and 3) the relatively high cost of ultrasonography. A retrospective study of DGTI at our institution was conducted to examine the necessity of routine duplex ultrasound after successful DGTI, along with a review of the relevant literature. Patient Population/Methods A retrospective review was conducted of 82 patients with iatrogenic arterial pseudoaneurysms (12 complex; 25.6%) treated with DGTI after initial diagnostic duplex ultrasonography. Immediate routine follow-up duplex ultrasound was performed on 71 of 82 cases (86.6%), whereas 11 patients received only clinical follow-up at the surgeon's discretion. Patient demographics, pseudoaneurysm anatomy, procedural details, outcomes, and complications were retrospectively documented and analyzed. Results From January 2002 to November 2003, 82 patients (59.8% women) underwent DGTI for pseudoaneurysm, with the majority located in the common femoral artery (48 of 82; 58.5%). Eighty pseudoaneurysms (97.6%) were treated with DGTI, with 78 (95.1%) being initially successful. Four of 78 (5%) follow-up examinations were judged to be of clinical significance: 2 of 78 patients (2.6%) became symptomatic and experienced pseudoaneurysm recurrence, whereas 2 of 78 patients were found to have an additional, previously undocumented, pseudoaneurysm. Three of these four resolved with a second injection, whereas one resolved without additional treatment. No thromboembolic, allergic, or infectious complications related to DGTI occurred. Conclusions In concert with the available literature, this cohort confirms that DGTI is a safe and effective treatment of iatrogenic arterial pseudoaneurysms with a low rate of recurrence, complication, and need for conversion to surgical intervention. DGTI should undoubtedly be the initial treatment of choice for pseudoaneurysms; however, follow-up duplex ultrasonography can be reserved for the clinically symptomatic patient.
Femoral Artery Blood Flow in Infants and Children
Authors: Kröger K. , Nettelrodt J. , Müntjes C. , Neudorf U. , Feuersenger A. , Schmaltz A. A. 
Published: March 2018

Background We measured Doppler parameter of common femoral artery (CFA) blood flow in infants and children and investigated how far these parameters change with age, height, weight, body mass index (BMI), and body surface area (BSA). Material and Methods CFA was investigated in 97 infants and children (43 females, 54 males, ages ranged from 0.13 to 220 months) on both sides in a supine position after 5 min rest using a 7.5-MHz linear transducer (Type Elegra, Siemens, Germany) 1 cm proximal to the femoral bifurcation. Peak systolic velocity, end-diastolic velocity, blood flow volume, mean average velocity, resistance index, and pulsatility index were measured. Results Theoretically, Doppler parameters could change with age, height, weight, BMI, and BSA. Because age, weight, height, and BSA were highly correlated (Spearman correlation coefficient > 0.90) only one of these variables could be included in a regression model. Only diameter and flow velocity (FV) correlated with age and height. Peak systolic velocity, mean average velocity, pulsatility index, and resistance index did not. Correlation between BMI and age and BMI and height was small. A regression model for the natural logarithm of FV was estimated: ln(FV) = −5.853 + 0.021 height + 0.049 BMI (R2 = 0.73, p < 0.0001 of height, p value of BMI: 0.028; p value of intercept: < 0.0001). The 95% confidence intervals were: −6.470 to −5.237 for the intercept, 0.006 to 0.093 for BMI, and 0.017 to 0.025 for height. Predicted FV and their 95% confidence intervals were calculated. The upper confidence limits were 8–10 times that of the lower ones. Conclusion Only FV showed height- and BMI-dependent changes in growing children. Prediction of FV in individual arteries was possible, but with a large range.
Preoperative Ultrasound Assessment for Dialysis Access Placement
Authors: Needham M. Ann 
Published: March 2018

Vascular access includes any form of cannulation of arteries or veins. For the treatment of chronic renal failure, this term refers to the ability to access both the arterial inflow and the venous outflow for the purpose of replacing the function of the kidney. This work provides a brief review of the history of hemodialysis and presents the method we use currently to map the arterial and venous system prior to placement of an arteriovenous fistula. The purpose is to present the process we use to determine the status of the arteries and the venous patency, as well as the flow diagram we use to determine the steps taken for each patient referred for preoperative vein mapping, including the worksheet used to collect the information for the surgeon. This work presents the minimum prerequisites that are thought to be necessary to create a viable arteriovenous fistula. A brief discussion of the criteria and protocol is presented that is used to diagnose steal syndrome from the hand. Billing codes are included when this procedure is used.
Neurofibromatosis Resulting in Carotid Aneurysms with Subsequent Rupture: Presentation and Follow-up Management with Duplex Ultrasound
Authors: Tuvell Nancy , Sorrell Kathryn 
Published: March 2018

Background Neurofibromatosis (NF) is a common genetic disorder responsible for the development of neuroectodermal tumors throughout the body. Although vascular involvement with these growths is uncommon, arteriovenous malformations, aneurysms, stenosis, and occlusions have been reported. We report a case of a patient with NF who presented with a ruptured internal carotid artery aneurysm and then developed a common carotid pseudoaneurysm with subsequent hemorrhage during repair. The use of duplex ultrasound (DU) in the initial diagnosis and follow-up management of this patient will be discussed. Case Report A 31 year-old man with a history of NF presented to the emergency department with pharyngitis and right neck swelling. The initial DU revealed a 2.4-cm distal right internal carotid artery (RICA) aneurysm, which was treated with a covered stent. On the first postoperative day, a new wall irregularity in the right common carotid artery measuring 1.6 cm and a high resistant Doppler signal in the RICA suggesting distal occlusion were demonstrated by DU. A transcranial duplex supported the ICA occlusion by demonstrating cross filling from the left to the right through the anterior communicating artery. Because of increased neck swelling, DU was repeated on the third day. At the site of the previously noted CCA irregularity, a 3.4-cm pseudoaneurysm had developed. During attempted repair in the endovascular suite, the patient developed massive hemorrhage. To control bleeding, intravascular coils were used to occlude the right external carotid artery, RICA, and right common carotid artery. An intraoperative DU confirmed the successful occlusion of the carotid vessels. Conclusion DU provided an accurate initial and follow-up diagnosis of the carotid aneurysms in a patient with vascular complications from NF.
Clinical Significance of Isolated Retrovalvular Deep Venous Thrombus
Authors: Hard Jonathan M. , Selis James E. 
Published: March 2018

Objective We sought to determine the natural progression of isolated thrombus behind valve leaflets in deep veins that is not associated with any other evidence of deep venous thrombosis (DVT). Methods We prospectively evaluated patients that were sent to us for evaluation of DVT. Duplex venous examination protocol established by the American College of Radiology was used. Only those patients who were found to have thrombus behind valve leaflets and did not have any other evidence of DVT were included in this study. Results During a period of 5 months, eight patients were found to have retrovalvular thrombus. The patients were further evaluated by follow-up duplex venous examination or telephone interview. The six patients in whom repeat duplex venous examination was performed demonstrated either no progression or complete resolution of thrombus. Two patients who refused to return for repeat duplex examination were reached for telephone interview and revealed no further symptoms that would indicate progression of deep vein thrombosis. Conclusions This study provides information on the natural course of isolated retrovalvular thrombus. These thrombi either remain stable or resolve and appear to not require anticoagulation. A large-scale study will be needed to corroborate these findings.
Impact of Postoperative Duplex Surveillance after Radiofrequency Ablation of the Greater Saphenous Vein
Authors: Stone Patrick A. , Armstrong Paul A. , Shames Murray L. , Back Martin R. , Johnson Brad L. , Flaherty Sarah K. , Bandyk Dennis F. 
Published: March 2018

Purpose Radiofrequency ablation (RFA) is an effective therapeutic option for the treatment of greater saphenous vein (GSV) insufficiency; however, recent reports have begun to document an associated incidence of postprocedural deep venous thrombosis (DVT) of up to 16%. We evaluated our incidence of DVT after RFA and the role of venous duplex ultrasonography (VUS) in the assessment and treatment of GSV reflux. Methods During a 17-month period, 62 lower extremities with symptomatic GSV reflux were evaluated by VUS in 51 patients (74% women; mean age 51 years, range 25–83 yrs). Clinical history and examination focusing on risk factors for venous insufficiency and DVT were obtained along with a complete preoperative bilateral lower-extremity VUS in all patients. All procedures were completed by performing an intraoperative VUS to confirm patency of the GSV and common femoral veins before and after RFA. All patients received outpatient complete lower-extremity VUS within 5 days of the procedure to assess technical success of the procedure and superficial and deep venous patency. Results Fifty (98%) of patients completed RFA, with one patient undergoing high ligation of the GSV because of our inability to pass a guidewire and catheter into the proximal GSV. Duplex ultrasound confirmed successful RFA of the GSV in all limbs treated. Stab phlebectomy was performed in 33 (53%) limbs for associated clusters of large varicose veins. Two postoperative DVTs occurred (2/62,3.2%), both of which were identified as a floating thrombus in the common femoral vein and which subsequently were treated with percutaneous catheter-directed suction thrombectomy without the need for extended anticoagulation therapy. Conclusion Duplex venous scanning is an important component in the diagnosis and treatment of GSV insufficiency. VUS not only is necessary to direct the success of these catheter-based ablative procedures but is mandatory to confirm the absence of extended DVT after the procedure is completed. Our series has recorded a relatively low incidence of DVT and demonstrates that early recognition and aggressive treatment of nonocclusive common femoral DVT after RFA can obviate the need for long-term anticoagulation and potentially the sequelae of deep venous thrombosis.
Lower Extremity venous Cross-Sectional Area Changes associated with Pregnancy
Authors: Pemble Lucia 
Published: March 2018

Objective This study aimed to assess the effect of posture on lower-extremity vein areas in primigravida women during pregnancy and postpartum. Methods Real-time duplex ultrasound was used to study 39 primigravida women (with no evidence of varicose veins or peripheral vascular disease) during pregnancy and postpartum to determine the areas of the superficial and deep leg veins. Vein areas where measured with the subjects in both supine and erect positions. These areas were than compared statistically for any differences between the right and left leg and for the significance of changes that occurred as the result of advancing pregnancy. The reversibility of pregnancy-induced changes was determined by comparison of postpartum results. Results No statistically significant differences were found between the veins of the right and left leg. Veins areas increased as pregnancy advanced and decreased postpartum. All vein areas measured with the subject in the erect position were larger than those obtained in the supine position. Vein area increases associated with advancing pregnancy were significant when measured in the supine position. Although vein areas measured in the erect position showed a similar trend, they did not show statistically significant changes. Conclusion Vein areas increased early in pregnancy and with advancing pregnancy continued to enlarge significantly when the subject was in the supine position. With the subject in the erect position, venous compliance reached a plateau by midpregnancy. With the veins then fully distended, the pregnancy induced changes, which continued with advancing pregnancy (blood volume expansion, hormonally induced decreased smooth muscle tone, pelvic vascular compression) coupled with increased hydrostatic pressure in the erect position must result in increased lower extremity venous pressure. The pregnancy induced vein changes were reversible postpartum.
Noninvasive Vascular Testing with the Surgeon Present in Planning and Maintenance of Arteriovenous Hemodialysis Access
Authors: Kiseleva Yelena A. , Caylor Kathy L. , Royer Ronson M. , Scoggins Eva A. , Davidson Ingemar J. , Clagett G. Patrick 
Published: March 2018

Background The goal of the study was to determine the incidence of upper extremity noninvasive vascular findings in guiding anatomic site and management strategies in the creation and maintenance of arteriovenous (AV) access for hemodialysis. All studies were performed with the surgeon present. Methods An ICAVL-accredited vascular laboratory database of upper extremity noninvasive vascular studies performed during a 12-month period was reviewed. The study group consisted of 152 end stage renal disease patients who received Doppler ultrasound and/or noninvasive physiologic testing for the purpose of assisting in planning or maintenance of hemodialysis access. The study group yielded a total of 252 exams as follows: (1) preoperative evaluation to determine site and suitability for use in AV access creation (n = 133); (2) existing AV access (AV fistula or graft) with clinical symptoms indicating malfunction and need for identifying the location and/or nature of the problem (n = 98); (3) finger arterial pressures and wave forms (with and without access compression) in patients with clinical symptoms of steal syndrome (n = 21). Results Of the 133 preoperative evaluations, 67 (51%) resulted in creation of an AV graft and 66 (49%) in an AV fistula. AV graft was chosen over fistula because of duplex findings of inadequate (<2 mm in diameter) or deep (>7 mm below skin level) veins. In all cases, the site and arm were determined by duplex findings and were marked preoperatively by the surgeon. In 72 (73.5%) of the 98 malfunctioning AV accesses, the etiology and site were identified by duplex ultrasound. These included thrombosing/failing access (n = 18, 25%), outflow venous stenosis (n = 16, 22.2%), inflow arterial stenosis (n = 15, 20.8%), anastomotic stenosis (n = 9, 12.5%), and miscellaneous causes (n = 14, 19.5%). Again, sites were marked by the access surgeon to guide intraoperative management. Steal was confirmed to be present in 11 (52%) of 21 patients and the surgeon determined the degree of arterial banding based on intraoperative changes in digital pressures. Conclusions Preoperative duplex scanning of upper extremity vasculature with the access surgeon present allows for accurate and precise planning in the creation of AV access. This has the potential to improve compliance with K/DOQI guidelines. Success in rescuing failing angioaccess is also enhanced by non-invasive testing in the presence of the operating surgeon.