Carotid Peak Systolic Velocity Research Articles

Fluid Responsiveness in Critically Ill Patients Using Carotid Peak Systolic Velocity Variability: A New Frontier.

Background and objectives A fluid responder is a patient who can increase his stroke volume/ cardiac output by more than 10%-15% after a fluid bolus. Left ventricular outflow tract (LVOT) velocity time integral (VTI) variability is widely used as an adynamic parameter of fluid responsiveness, but a transthoracic echo view of LVOT VTI is often time-consuming and, at times, difficult to achieve. So, in the quest for another parameter that might equally be a good surrogate marker of stroke volume variation, carotid peak systolic velocity (CPSV) variation has been studied. The objective was to assess CPSV variation in patients who are already fluid responders. Methods The sample size was calculated considering a minimum correlation coefficient of 0.5. Adult patients in whom the physician wanted to give a fluid bolus and whose average LVOT VTI was more than 15% over 3 respiratory cycles were included in the study. Demographic variables, along with hemodynamic parameters such as heart rate, blood pressure, the need for vasopressors, mode of breathing (spontaneous or mechanical ventilation), andCPSV variation,were noted and averaged over three respiratory cycles. Fluid bolus (Plasmalyte) 6 ml/kg bolus over 10-15 minutes. Post-fluid hemodynamic variables, along with averaged LVOT VTI over three respiratory cycles and averaged CPSV variation over three respiratory cycles, are noted. Results Thirty adult patients were evaluated in the study. In spontaneously breathing patients (n=12), the average CPSV variation expressed as mean + standard deviation before and after fluid administration of 6ml/kg of ideal body weight was 14.1 ± 3.4 and 5.4 ± 2.6, respectively (p < 0.05). In mechanically ventilated patients (n=18), the average CPSV variation expressed as mean + standard deviation before and after fluid administration of 6ml/kg of ideal body weight fluid was 15 ± 5.3 and 6.5 ± 3.1, respectively (p <0.005). Overall, there was a statistically significant positive correlation between LVOT VTI variation and CPSV variation before fluid therapy (correlation coefficient 0.56 and p-value 0.001) and a statistically significant moderate positive correlation post-fluid therapy (correlation coefficient 0.37 and p-value 0.043). Conclusion We found a significant decrease in CPSV variation post-fluid administration in patients who are fluid responders, which mimics a decrease in stroke volume variation after fluid administration in patients who are fluid responsive.

Immediate hemodynamic effects of transcatheter aortic valve replacement on left ventricular stroke volume and carotid artery blood flow

IntroductionTranscatheter aortic valve replacement (TAVR) is performed in selected patients with severe aortic valve stenosis, leading to immediate relief of left ventricular outflow obstruction. The purpose of this study was to evaluate the immediate hemodynamic effects of TAVR on left ventricular stroke volume (SVLVOT) and common carotid artery stroke volume (SVCCA). Material and methodsTwenty-five TAVR patients were included in this prospective observational study. Patients were treated under either local, or general anesthesia. Echocardiographic, and carotid ultrasound measurements were performed in the operating room pre (T1), and post (T2) TAVR. Changes in SVLVOT, SVCCA, carotid peak systolic velocity (PSV), pulsatility index (PI) and other carotid Doppler parameters were evaluated. ResultsFollowing TAVR, the aortic valve area (AVA) increased from 0.8 [0.6–0.9] to 1.9 [1.6–2.3] cm2 (p < 0.001), and the peak transvalvular gradient (PGAV) decreased from 70 [65–81] to 15 [11-18] mm Hg (p < 0.001) from T1 to T2. SVLVOT increased from 58 ± 17 to 69 ± 24 ml, p < 0.01, whereas SVCCA remained unchanged (from 10 [7-11] to 10 [8-11] ml, p = 0.50). Δ SVLVOT was 19 [7–31] % and Δ SVCCA was 1 [-7-20] %, p < 0.05. PSV increased from 68 ± 17 to 81 ± 17 cm/s, p < 0.001, and PI increased from 1.7 [1.5–2.2] to 2.2 [1.7–2.6], p < 0.001. ConclusionSuccessful TAVR resulted in immediate improvement of left ventricular stroke volume, whereas carotid stroke volume remained unchanged.

Shear wave elastography to evaluate carotid artery elasticity in long-term drinkers with varying degrees of alcoholic fatty liver disease.

To evaluate carotid artery elasticity in long-term drinkers with varying degrees of alcoholic fatty liver disease (AFLD) by shear wave elastography (SWE). Of the 92 drinkers with alcohol drinking for greater than or equal to 5 years, were fell into three groups depending on the liver ultrasound results: group B (without AFLD), group C (with mild AFLD), and group D (moderate-to-severe AFLD). Another 32 healthy adults were selected as the control group (group A). All participants had no significant carotid plaque. Gray scale ultrasound and color doppler ultrasound were used to obtain the left common carotid peak systolic velocity (PSV), carotid diastolic internal diameter (Dd ), carotid intima-media thickness (IMT), carotid systolic internal diameter (Ds ) and the stiffness coefficient (β). Mean values of mean elastic modulus (MEmean ), minimum elastic modulus (MEmin ), and maximum elastic modulus (MEmax ) of the anterior wall of the left common carotid artery at end-diastole were measured by SWE. Dd , Ds , and PSV among the four groups showed no differences. (all P > 0.05). Compared with groups A and B, MEmin , MEmax , and MEmean were significantly higher in group C (all P < 0.05), while IMT and β were not statistically different (all P > 0.05). MEmean , MEmin , MEmax , IMT, and β were significantly higher in group D compared with the other three groups (all P < 0.05). No significant differences were observed in IMT, β, MEmean , MEmax , and MEmin between groups A and B (all P > 0.05). Shear wave elastography can provide a quantitative evaluation for the carotid artery elasticity in long-term drinkers with varying degrees of AFLD.

Carotid doppler indices do not predict fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting surgery.

This study aimed to determine the predictive value of carotid artery blood flow (CABF), corrected carotid flow time (CFT), and respiratory variation in carotid peak systolic velocity (DVPeakCA) for fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting (CABG) surgery. It also aimed to correlate each of these indices with changes in stroke volume index (SVI) after a fluid bolus. This prospective, interventional, before-after study recruited 45adult patients undergoing CABG. Following induction of anesthesia, a fluid challenge of 6 ml/kg of a crystalloid solution was delivered over 10 min. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), CABF, CFT, and DVPeakCA were recorded before and following the intervention. Patients with an increase in SVI of >15% from baseline were considered responders. We had 22 responders and 23 nonresponders. Areas under the receiver operating characteristic (AUROC) curves for the studied indices (CABF, 0.516, CFT, 0.502, and DVPeakCA, 0.671) did not suggest any strong predictive value to detect fluid responsiveness. Similarly, the r values for correlation of these carotid doppler-derived indices, both baseline and as % change from baseline with the % alteration of SVI were all <0.2, which demonstrates a very weak correlation between these variables. Carotid doppler indices are unreliable to assess fluid responsiveness, and cannot replace invasive methods of analyzing preload optimization. There was no significant correlation between carotid doppler-derived indices and alterations in SVI before and after the fluid bolus.

Carotid Intima-media Thickness/Diameter Ratio and Peak Systolic Velocity as Risk Factors for Neurological Severe Ischemic Events in Takayasu Arteritis

To characterize Takayasu arteritis (TA) with supra-aortic involvement and determine the associations between clinical features, carotid ultrasonographic (US) variables, and neurological severe ischemic events (SIEs). Patients with supra-aortic involvement including brachiocephalic trunk, bilateral common carotid artery and internal carotid artery, and bilateral subclavian and vertebral artery and baseline carotid US examination were enrolled from the East China TA cohort. Bilateral carotid diameter, intima-media thickness (IMT), and peak systolic velocity (PSV) were measured by US. Then, the IMT/diameter ratio (IDR) was calculated. Risk factors associated with neurological SIEs were analyzed by multivariate logistic regression. In total, 295 patients were included, of whom 260 (88.14%) were female, and 93 (31.53%) experienced neurological SIEs. Involved supra-aortic artery distribution (P = 0.04) and number (P < 0.01) differed between subjects with neurologic and nonneurologic SIEs, showing higher prevalence of common carotid and vertebral artery involvement after Bonferroni correction and 56.99% patients having ≥ 4 involved arteries in the neurological SIE group. The bilateral IDR (P < 0.01) differed between patients with and without neurological SIEs. The carotid IDR (left: cut-off value ≥ 0.55, OR 2.75, 95% CI 1.24-6.07, P = 0.01; right: ≥ 0.58, OR 2.70, 95% CI 1.21-6.02, P = 0.01) and left carotid PSV (≤ 76.00 cm/s, OR 3.09, 95% CI 1.53-6.27, P < 0.01), as well as involved supra-aortic artery number (≥ 4, OR 2.33, 95% CI 1.15-4.72, P = 0.02) were independently associated with neurological SIEs. The carotid IDR and PSV might be performed as valuable markers for recognizing neurological SIEs in patients with TA with supra-aortic lesions.

Carotid doppler indices with age and body mass index in a sampled Nigerian population

Background: Carotid doppler studies are frequently carried out to assess for possible stenosis resulting from presence of carotid plaques. The carotid peak systolic velocity (PSV) and end diastolic velocity (EDV) are key indices for determining the severity of the stenosis. However, normative values of these parameters may be dependent on anthropological variables like age and body mass index (BMI)Objective: The study was aimed at assessing the variations of PSV and EDV with age and BMI in a sampled Nigerian population.Materials and Methods: A total of 204 participants (72 males and 132 non-gravid females) aged between 20 and 70 years who were normotensive with no cardiovascular diseases were selected. Their ages, BMI, PSV and the EDV were measured using standard protocols for the four segments of the carotid artery: common carotid (CC), carotid bulb (CB), internal carotid (IC) and the external carotid (EC). Data obtained were presented using tables and line graphs while the analysis of variance (ANOVA) was used to determine significant difference in measurement across the groups.Results: The mean PSV recorded were 88.25 ± 7.43 cm/s for the CC, 73.93 ± 6.23 cm/s for the IC, 51.01 ± 4.30 cm/s for the CB and 50.41 ± 4.25 cm/s for the EC. There was a steady increase of the PSV between 20 and 46 years from 74.91 cm/s to 98.78 cm/s for the CC, from 62.76 cm/s to 82.75 cm/s for the IC, from 42.80 cm/s to 56.43 cm/s for the EC and from 43.30 cm/s to 57.10 cm/s for the CB. The maximum EDV measured for the IC was (24.75 ± 2.11 cm/s). Others were 21.12 ± 1.8 cm/s for the CC, 19.38 ± 1.65 cm/s for CB and 16.92 ± 1.44 cm/s for the EC. The EDV also increased steadily between 20 to 46 years from 17.76 cm/s to 23.68 cm/s for the CC, from 21.04 cm/s to 27.75 cm/s for the IC, from 14.38 cm/s to 18.97 cm/s for the EC and from 16.48 cm/s to 21.73 cm/s for the CB. The PSV and EDV varied significantly with age (p &gt;0.05). Also, the PSV and EDV increased slightly with increasing BMI from 30 – 31.9 kg/m2. For a BMI of 20 kg/m2 to 32 kg/m2, the increase in PSV were from 79.48 cm/s to 90.75 cm/s for the CC, from 66.58 cm/s to 76.03 cm/s for the IC, from 45.40 cm/s to 51.85 cm/s for the EC and from 45.94 cm/s to 52.46 cm/s for the CV. Similarly, the PSV and EDV values decreased at a BMI of 30 – 31.99 kg/m2. Thus, the BMI was significantly associated with PSV and EDV across all segments of the carotid artery (p &gt; 0.05).Conclusion: arotid PSV and EDV with age and BMI. These variations should be taken in to consideration when diagnosis on alterations in carotid artery flow are to be made using PSV and EDV values.

CAROTID DOPPLER INDICES WITH AGE AND BODY MASS INDEX IN A SAMPLED NIGERIAN POPULATION

Background: Carotid Doppler studies are frequently carried out to assess for possible stenosis resulting from the presence of carotid plaques. The carotid peak systolic velocity (PSV) and end-diastolic velocity (EDV) are key indices for determining the severity of the stenosis. However, normative values of these parameters may be dependent on anthropological variables like age and body mass index (BMI) Objective: The study was aimed at assessing the variations of PSV and EDV with age and BMI in a sampled Nigerian population. Materials and Methods: A total of 204 participants (72 males and 132 non-gravid females) aged between 20 and 70 years who were normotensive with no cardiovascular diseases were selected. Their ages, BMI, PSV and the EDV were measured using standard protocols for the four segments of the carotid artery: common carotid (CC), carotid bulb (CB), internal carotid (IC) and the external carotid (EC). Data obtained were presented using tables and line graphs while the analysis of variance (ANOVA) was used to determine the significant differences in measurement across the groups. Results: The mean PSV recorded were 88.25 ± 7.43 cm/s for the CC, 73.93 ± 6.23 cm/s for the IC, 51.01 ± 4.30 cm/s for the CB and 50.41 ± 4.25 cm/s for the EC. There was a steady increase of the PSV between 20 and 46 years from 74.91 cm/s to 98.78 cm/s for the CC, from 62.76 cm/s to 82.75 cm/s for the IC, from 42.80 cm/s to 56.43 cm/s for the EC and from 43.30 cm/s to 57.10 cm/s for the CB. The maximum EDV measured for the IC was (24.75 ± 2.11 cm/s). Others were 21.12 ± 1.8 cm/s for the CC, 19.38 ± 1.65 cm/s for CB and 16.92 ± 1.44 cm/s for the EC. The EDV also increased steadily between 20 to 46 years from 17.76 cm/s to 23.68 cm/s for the CC, from 21.04 cm/s to 27.75 cm/s for the IC, from 14.38 cm/s to 18.97 cm/s for the EC and from 16.48 cm/s to 21.73 cm/s for the CB. The PSV and EDV varied significantly with age (p &gt; 0.05). Also, the PSV and EDV increased slightly with increasing BMI from 30 – 31.9 kg/m2. For a BMI of 20 kg/m2 to 32 kg/m2, the increase in PSV were from 79.48 cm/s to 90.75 cm/s for the CC, from 66.58 cm/s to 76.03 cm/s for the IC, from 45.40 cm/s to 51.85 cm/s for the EC and from 45.94 cm/s to 52.46 cm/s for the CV. Similarly, the PSV and EDV values decreased at a BMI of 30 – 31.99 kg/m2. Thus, the BMI was significantly associated with PSV and EDV across all segments of the carotid artery (p &gt; 0.05). Conclusion: There are significant variations in carotid PSV and EDV with age and BMI. These variations should be taken into consideration when diagnoses on alterations in carotid artery flow are to be made using PSV and EDV values.

The Relationship between Circulating Levels of Osteopontin with Carotid Intima-Media Thickness in Children on Regular Hemodialysis

Background: Chronic kidney disease (CKD) is associated with cardiovascular morbidity and mortality. Osteopontin (OPN) is a critical factor in developing atherosclerosis and increases the risk for a major adverse cardiovascular event. Aim: To investigate osteopontin serum levels in hemodialysis children and detect the association between the main arteries’ intimal medial thickness (IMT) and peak systolic velocity. Material and Methods: This case-control study included 30 children on regular hemodialysis and 30 children age and sex-matched as controls their age range from 4 to 18 years; we investigated osteopontin serum level in addition to the Doppler ultrasound assessment of intimal medial thickness and peak systolic velocity (PSV) of the main arteries in the same line with the traditional markers of the routine investigations of children on regular hemodialysis. Results: Significantly high osteopontin level in hemodialysis children than the controls was (0.85 ± 0.21 ng/ml) (0.69 ± 0.26 ng/ml), respectively (p = 0.026). A significant increase in the (IMT) of the main arteries, including the carotid and femoral arteries, in the patient’s group than the controls, was (0.51 ± 0.01 mm) (0. 69. ± 0.01 mm) (0.32 ± 0.036 mm) (0.55 ± 0.01), respectively (p = 0.001). There is a strong correlation between (OPN) with the (IMT) of carotid and femoral arteries, a significant positive correlation between (OPN) with urea, creatinine, triglyceride, PTH, ferritin, CRP, and ESR, and a negative correlation with RBCs count and carotid PSV. Conclusion: High osteopontin level is consistent with the increased IMT of the main arteries in hemodialysis children that seem to play a significant role in developing and propagating atherosclerosis in hemodialysis children, evidenced by significant association with inflammatory markers and uremic toxins.

Surrogate indices of aortic peak systolic velocity variation to monitor fluid responsiveness in pediatric non-cardiac surgery: a prospective observational study.

Aortic peak systolic velocity variation (ΔVpeakAo) is a reliable dynamic indicator of preload in mechanically ventilated children. However, easily measurable alternative parameters like carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakSs) are not well evaluated in children. The aim of the study was to find correlation between ΔVpeakCa and ΔVpeakSs to ΔVpeakAo, as potential surrogate markers of fluid responsiveness. 52 children, 1-12years old, undergoing major non-cardiac surgeries under general endotracheal anaesthesia were recruited for this single-centre prospective observational study. ΔVpeakAo, ΔVpeakCa and ΔVpeakSs were measured by pulsed wave Doppler in appropriate windows, measuring maximum and minimum peak flow velocity over a single respiratory cycle. Calculated parameters were compared by a repeated measures study design. Correlation coefficients were 0.82 between ΔVpeakAo and ΔVpeakSs and 0.73 between ΔVpeakAo and ΔVpeakCa. Bland-Altman analysis showed minimal bias of 1.86 percentage points with limits of agreement of 11.21 to - 7.49 (ΔVpeakAo and ΔVpeakSs) and 3.93 percentage points with limits of agreement of 14.04 to - 6.18 (ΔVpeakAo and ΔVpeakCa). ΔVpeakSs and ΔVpeakCa also showed good discrimination to predict ΔVpeakAo (lying in previously validated fluid responsive zones) with sensitivities and specificities of 82.25% and 85% with cut-off of 11% for ΔVpeakSs, and 88.52% and 70% with cut-off of 8.6% for ΔVpeakCa. Carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakCa) can be potential surrogate markers for Aortic peak systolic velocity variation (ΔVpeakAo) in assessing fluid responsiveness in mechanically ventilated children.Study registration: Clinicaltrials.gov ID NCT03155555.

Flow Patterns in the Carotid Arteries of Patients with Left Ventricular Assist Devices

The aim of this study is to evaluate and define the expected flow pattern changes of carotid artery duplex ultrasound after left ventricular assist device (LVAD) placement. Retrospective review of Henry Ford Hospital database of patients who had undergone LVAD placement between March 2008 and July 2012 was performed. All patients who had carotid artery duplex scanning before and after LVAD placement within 2 years of each other and showed <50% stenosis were included in this study. Type of waveform, carotid peak systolic velocity, and end-diastolic velocities were analyzed, and the values were compared before and after LVAD placement. A total of 13 patients with LVAD had at least 2 carotid duplex studies before and after LVAD placement within 2 years of each other. Of those, 92% (n=12) were men, and 61% (n=8) were Caucasian. Mean age was 61years old. The HeartWare ventricular assist device was implanted in 4 patients and the HeartMate II left ventricular assist device was implanted in 9 patients. Post-LVAD Doppler imaging demonstrated parvus tardus waveform. Analysis of flow velocities revealed that peak systolic velocity was diminished after LVAD placement in both the internal and common carotid arteries (P=0.006 and P<0.0001, respectively). End-diastolic velocity, however, increased post-LVAD (P<0.0001). Interestingly, mean flow velocities in both the common and internal carotid arteries remained stable after LVAD placement. This study reveals changes in waveform morphology and peak systolic and diastolic velocities in the common and internal carotid arteries on carotid duplex after LVAD placement. Additionally, it shows that despite changes in post-LVAD pulse pressure in the carotid arteries, the mean flow velocity remained unchanged.

Respiratory variation in carotid peak systolic velocity predicts volume responsiveness in mechanically ventilated patients with septic shock: a prospective cohort study.

BackgroundThe evaluation of fluid responsiveness in patients with hemodynamic instability remains to be challenging. This investigation aimed to determine whether respiratory variation in carotid Doppler peak velocity (ΔCDPV) predicts fluid responsiveness in patients with septic shock and lung protective mechanical ventilation with a tidal volume of 6 ml/kg.MethodsWe performed a prospective cohort study at an intensive care unit, studying the effect of 59 fluid challenges on 19 mechanically ventilated patients with septic shock. Pre-fluid challenge ΔCDPV and other static or dynamic measurements were obtained. Fluid challenge responders were defined as patients whose stroke volume index increased more than 15 % on transpulmonary thermodilution. The area under the receiver operating characteristic curve (AUROC) was compared for each predictive parameter.ResultsFluid responsiveness rate was 51 %. The ΔCDPV had an AUROC of 0.88 (95 % confidence interval (CI) 0.77–0.95); followed by stroke volume variation (0.72, 95 % CI 0.63–0.88), passive leg raising (0.69, 95 % CI 0.56–0.80), and pulse pressure variation (0.63, 95 % CI 0.49–0.75). The ΔCDPV was a statistically significant superior predictor when compared with the other parameters. Sensitivity, specificity, and positive and negative predictive values were also the highest for ΔCDPV, with an optimal cutoff at 14 %. There was good correlation between ΔCDPV and SVI increment after the fluid challenge (r = 0.84; p < 0.001).ConclusionsΔCDPV can be more accurate than other methods for assessing fluid responsiveness in patients with septic shock receiving lung protective mechanical ventilation. ΔCDPV also has a high correlation with SVI increase after fluid challenge.

Relationship between noninvasive and invasive blood pressure values in end-stage renal disease patients on dialysis

End-stage renal disease (ESRD) is complicated by high blood pressure (BP) and severe atherosclerosis, which may lead to different values of BP measured by invasive and noninvasive methods. However, the differences in BP values between these two methods and their possible mechanisms in ESRD have not been investigated. Forty-one ESRD patients on dialysis were enrolled in the present study. Invasive BP, noninvasive BP, and carotid hemodynamic variables were obtained through radial artery catheterization, oscillometric methods, and echoarteriography, respectively. We found that noninvasive systolic BP (NISBP) was 30±20 mmHg (P<0.001) lower than invasive systolic BP (INSBP), whereas no significant difference was found in diastolic BP between these two methods. The difference between INSBP and NISBP was correlated with carotid peak systolic velocity (r=0.3550, P=0.0229). NISBP could not accurately represent INSBP in ESRD patients on dialysis. The lack of dynamic pressure measurement during NISBP measurement may contribute to the difference between NISBP and INSBP.

Breast arterial calcifications and carotid intima-media thickness and haemodynamics: Is there any association?

In this study, we aimed to research the relation between breast arterial calcifications (BACs) detected on mammography and two well-known markers of cardiovascular diseases-carotid artery intima-media thickness (C-IMT) and haemodynamics parameters like carotid peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI). The study group consisted of 50 consecutive BAC (+) women and the control group consisted of 55 BAC (-) women. In all participants, BAC was diagnosed using mammography and C-IMT was measured using B-mode and Doppler ultrasonography. BAC was defined as two linear calcification depositions in a conical periphery or as calcific rings at the mammographic evaluation. Doppler spectrum samples were obtained from 2 cm proximal to the main carotid artery bifurcation. Postmenopausal female patients ranging in age from 40 to 86 included in this study. When the groups were adjusted for age, a statistically significant difference was found between mean C-IMT of BAC (+) and BAC (-) groups (0.81 ± 0.2 vs. 0.69 ± 0.2 mm; p<0.001). No significant differences were observed between BAC (+) and BAC (-) groups in terms of PSV, EDV, RI. The findings of the present study suggest that BAC, diagnosed by mammography, is independently associated with C-IMT. C-IMT measurement is suggested as a useful tool to detect early atherosclerotic changes. However, haemodynamic variables (PSV, EDV, RI) were not statistically different between the BAC (+) and BAC (-) groups. Prospective larger cohort studies are needed to further elucidate whether BAC is an independent risk factor for cardiovascular disease.

Is there a concordance between carotid and penile cavernosal artery intima-media thickness in patients with erectile dysfunction?

This study aimed to investigate the predictive accuracy of carotid and cavernosal Doppler ultrasound findings for discriminating patients with vasculogenic erectile dysfunction (ED). Fifty patients with complaints of ED were included. B-mode ultrasound of bilateral carotid arteries were performed and peak systolic velocity (PSV), end-diastolic velocity (EDV) and intima-media thickness (IMT) values were measured. Afterwards, corresponding values of cavernosal arteries were obtained by penile color duplex ultrasonography (P-CDU). Of total 50 patients, 29 (58%) were included in vasculogenic ED group and 21 (42%) in non-vasculogenic ED group according to P-CDU findings. There was a significant difference between groups for cavernosal IMT (P=0.012) but not for carotid IMT (P=0.601). When patients were reclassified according to carotid IMT values (IMT of the first group <0.9 mm and the second ≥0.9 mm), carotid PSV and EDV values were different (P=0.033 and 0.018, respectively). Cavernosal PSV and EDV displayed no difference (P=0.816 and 0.123) while cavernosal IMT and percent change of cavernosal caliper were significantly different (P=0.014 and 0.018). Carotid PSV and EDV successfully mirrored respective measurements in cavernosal artery. However, carotid IMT failed to demonstrate such a correlation. Cavernosal IMT seems promising as an additional tool in the evaluation of cavernosal function.

Innominate Artery Occlusive Disease: Sonographic Findings

The objective of this study was to report the sonographic abnormalities in a group of patients with angiographically proven innominate artery stenosis and occlusion. A review of all cerebrovascular sonograms at our institutions was undertaken to identify patients with complete or partial flow reversal in the right vertebral artery and reversal or midsystolic deceleration of flow in any one of the three major segments of the right carotid system (common, internal, or external carotid artery). The distribution and appearance of these abnormalities was evaluated, and the presence or absence of tardus-parvus waveforms was noted in any segment of the right carotid artery. Additionally, a left to right common carotid peak systolic velocity ratio (LCCA/RCCA) was calculated and compared to published normal values. All patients had correlative contrast or MR angiography. Correlation was made between the severity of stenosis as determined by angiographic images and waveform aberrations as well as the more objective LCCA/RCCA ratios. Twelve patients were identified as having the abnormalities described above in the right vertebral and carotid arteries. Doppler waveforms from the right vertebral artery revealed that eight of the 12 patients had complete reversal of flow at rest. Bidirectional flow was found in the remaining four as manifested by the presence of marked midsystolic deceleration. In the carotid arteries, one patient had complete reversal of flow in all segments of the right carotid system. Waveforms with midsystolic deceleration were identified in at least one of the carotid arteries of the remaining 11 patients: common carotid artery (8/11 = 73%), internal carotid artery (10/11 = 91%), external carotid artery (3/11 = 27%). The average LCCA/RCCA was 3.1 with a range of 1.7 to 5.7 (normal = 0.7-1.3). All patients had severe innominate artery disease (from 70% to occlusion) by contrast angiography or MR angiography. There was no correlation between the angiographically determined degree of stenosis and the Doppler findings. A distinctive pattern of hemodynamic alterations occurs in the right vertebral and carotid arteries of patients with severe innominate artery disease. Findings include reversed or bidirectional flow in the right vertebral artery, the presence of midsystolic deceleration in any of the branches of the right carotid system, and elevated LCCA/RCCA ratio.