Color Duplex Sonography Research Articles

Comparison of radial artery occlusion occurrence (RAO) between compression band device and manually applied gauze compression after transradial coronary procedure, a PROBE study

Abstract Funding Acknowledgements Type of funding sources: None. Background Hemostasis of the radial artery after transradial coronary procedure can be achieved either manually by means of a gauze or mechanically through a device compression band, and radial artery occlusion (RAO) is one of its common complications. Purpose The study sought to compare the occurrence of RAO between the two hemostasis methods being used after a transradial coronary procedure to determine an effective and safe method that can be recommended for use. Methodology This was a Prospective, Randomized Open-label Blinded Endpoint (PROBE) study. A total of 137 patients undergoing a transradial coronary procedure were randomized equally using block randomization sampling technique. Radial artery patency was evaluated by color duplex ultrasonography within 24-72 hours after the procedure. The primary endpoint was early RAO. Secondary endpoints included complications such as access-site bleeding, pain, and hematoma. Results Three (2.19%) early RAOs occurred, 1 (1.47%) in the band compression device group and 2 (2.9%) in the manual gauze compression group (p= 1.000). There were no significant differences between the 2 groups regarding access-site bleeding [type 1 bleeding, 3 (4.48%) vs 2 (2.90%); p= 0.678]; pain with median pain score of 0 (0-6) vs 0 (0-7); p= 0.742; and hematoma [Grade I: 3 (4.41%)vs 2 (2.9%); Grade II: 0 vs 2 (2.9%); Grade III: none, and Grade IV: 0 vs 2 (2.9%); p= 0.363]. Conclusion Compression Band Device and Manually Applied Gauze Compression have similar rates of early RAO, access-site bleeding, pain, and hematoma.

Epidemiological Aspects of the Carotid Artery Disease in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Background and aims: Concomitant carotid artery disease (CaAD) in patients referred to coronary surgical revascularization is a strong hazard to perioperative stroke. The current study addressed the epidemiology features of concomitant CaAD in patients referred to a coronary surgical revascularization center. Methods: This descriptive-analytical cross-sectional study was conducted on all incoming patients to coronary surgical revascularization for two years at a single center who underwent a color duplex-sonography (CDS) interrogation. The demographic, clinical, echocardiographic, coronary angiographic, and color duplex-sonographic data were collected from patients’ medical records. Quantitative and qualitative data were expressed as means and standard deviations, as well as numbers and percentages, respectively. The relationships between quantitative and qualitative variables were investigated using Pearson’s correlation and chi-square test, respectively. Results: In total, 430 patients with a mean age of 66.3±9.9 years were included (35% females) in the study. Preoperative CDS was performed on 82% of patients; in addition, 29% of them presented with an increased intima-media ratio, and CtAD was observed in 51%. Based on the results, 77 and 143 patients were detected with unilateral and bilateral involvement, respectively. Severe carotid stenosis accounted for 4% of patients. Age older than 65 years (P=0.02), unstable angina (P=0.045), and the presence of an occluded coronary artery (P=0.002) were associated with the presence of CtAD. Finally, the severity of the left and right carotid stenosis was associated with diabetes mellitus (P<0.05). Conclusion: The prevalence of concomitant CtAD in patients referred to coronary surgical revascularization remains high. The current data warn of the necessity of performing preoperative CDS routinely.

Effects of plaque characteristics and artery hemodynamics on the residual stenosis after carotid artery stenting

ObjectiveCarotid artery stenting (CAS) has become an alternative strategy to carotid endarterectomy for carotid artery stenosis. Residual stenosis was an independent risk factor for restenosis, with the latter affecting the long-term outcomes of CAS. This multicenter study aimed to evaluate the echogenicity of plaques and hemodynamic alteration by color duplex ultrasound (CDU) examination and investigate their effects on the residual stenosis after CAS. MethodsFrom June 2018 to June 2020, 454 patients (386 males and 68 females) with a mean age of 67.2 ± 7.9 years, who underwent CAS from 11 advanced stroke centers in China were enrolled. One week before recanalization, CDU was used to evaluate the responsible plaques, including the morphology (regular or irregular), echogenicity of the plaques (iso-, hypo-, or hyperechoic) and calcification characteristics (without calcification, superficial calcification, inner calcification, and basal calcification). One week after CAS, the alteration of diameter and hemodynamic parameters were evaluated by CDU, and the occurrence and degree of residual stenosis were determined. In addition, magnetic resonance imaging was performed before and during the 30-day postprocedural period to identify new ischemic cerebral lesions. ResultsThe rate of composite complications, including cerebral hemorrhage, symptomatic new ischemic cerebral lesions, and death after CAS, was 1.54% (7/454 cases). The rate of residual stenosis after CAS was 16.3% (74/454 cases). After CAS, both the diameter and peak systolic velocity (PSV) improved in the preprocedural 50% to 69% and 70% to 99% stenosis groups (P < .05). Compared with the groups without residual stenosis and with <50% residual stenosis, the PSV of all three segments of stent in the 50% to 69% residual stenosis group were the highest, and the difference in the midsegment of stent PSV was the largest (P < .05). Logistic regression analysis showed that preprocedural severe (70% to 99%) stenosis (odds ratio [OR], 9.421; P = .032), hyperechoic plaques (OR, 3.060; P = .006) and plaques with basal calcification (OR, 1.885; P = .049) were independent risk factors for residual stenosis after CAS. ConclusionsPatients with hyperechoic and calcified plaques of the carotid stenosis are at a high risk of residual stenosis after CAS. CDU is an optimal, simple and noninvasive imaging method to evaluate plaque echogenicity and hemodynamic alterations during the perioperative period of CAS, which can help surgeons to select the optimal strategies and prevent the occurrence of residual stenosis.

A clinical study of ultrasonic localization-assisted combined transplantation of a bilateral anterolateral thigh perforator flap for the repair of large-area skin and soft tissue defects of the extremities.

The aim of this study was to investigate the clinical efficacy of the combined transplantation of a bilateral anterolateral thigh perforator (ALTP) flap for the repair of large-area skin and soft tissue defects of the extremities. Twelve patients who had received bilateral ALTP flap reconstructions for large-area skin and soft tissue defects of the extremities were retrospectively analyzed. The areas of the skin and soft tissue defects were measured preoperatively (18.0×11.0 ‒ 38.0×15.0 cm2). The wounds were on the forearm, elbow, upper arm, foot, and lower leg. Color Duplex Sonography (CDS) was used to localize the site where the perforator artery of the bilateral thighs penetrated the deep fascia. The selected area was evaluated according to the number of perforating branches and the range of supply. The flap areas and repairable range were further evaluated according to the number of perforating branches detected during the operation to determine whether to retain the deep fascia. It is important to design and adjust the anastomosis of the vascular pedicle according to the specific situation on transfer of the flap to the recipient site. The donor sites of all the patients in the study were closed in the first stage. The amount of bleeding and the blood supply to the flap after vascular anastomosis were evaluated during the operation. The postoperative survival of the flap and complications, such as bleeding, infection, and arteriovenous crisis, were closely monitored. All patients were followed-up at one, three, and six months after surgery to assess their satisfaction with the appearance of the flap transplantation and the recovery of limb function. The bilateral ATLP flaps survived successfully in all 12 cases and all donor sites were closed in the first stage. No post-surgery complications, including hematoma, wound dehiscence, and infection, were observed at the donor sites, resulting in high patient satisfaction. Combined transplantation of bilateral ALTP flaps can repair large-area skin and soft tissue defects in one stage, which not only reduces the number of operations and hospitalization costs but also reduces the damage to the limbs caused by the cutting of large-area flaps from only one side. The accuracy of the surgery was improved by ultrasound-assisted localization. In summary, combined transplantation of bilateral ALTP is a rational yet effective way to repair large-area skin and soft tissue defects of the extremities.

Updates on the diagnosis and monitoring of giant cell arteritis.

This mini-review offers a critical appraisal of the currently employed imaging or histopathological tools to diagnose and monitor giant cell arteritis (GCA). An overview of the most updated evidence and current application of color duplex ultrasonography (US), temporal artery biopsy (TAB), 18-fluorodeoxyglucose [18F] FDG-PET/CT, magnetic resonance imaging, and computed tomography angiography is provided. The main limitations of each tool, and the most relevant research developments are discussed. The review highlights the complementary value of the available modalities to ensure a correct diagnosis of GCA, and to provide valuable prognostic information. Novel evidence is accumulating to support the role of imaging, and particularly US, as a monitoring tool for the disease, opening new perspectives for the future management of large vessel vasculitis.

Perforator mapping and clinical experience with the superthin profunda artery perforator flap for reconstruction in the upper and lower extremities

Thin skin flaps have gained popularity for extremity reconstruction. However, the use of the profunda artery perforator (PAP) flap has not been explored as much. With its concealed donor site on the medial thigh and bulk, the PAP has become popular for reconstruction in the breast, head, and neck. The thickness of the subfascial PAP flap is decreased through elevation on the thin or superthin plane, making it more suitable for extremity reconstruction. A consecutive series of 28 patients with 29 flaps who received a thin or superthin single perforator PAP flap for upper or lower extremity reconstruction was reviewed. Our technique for preoperative localization of the dominant perforator using computed tomography angiography (CTA) and color duplex ultrasonography (CDU) is described. Flap success rate was 93.1%. Mean flap artery diameter, vein diameter, area, and thickness were 1.7+0.4mm, 2.2+0.4mm, 157.3+52.1cm2, and 0.7+0.2cm, respectively. Skin thickness at the suprafascial bifurcation point of a dominant "T" perforator measured on preoperative CTA correlated with actual intraoperative flap thickness. Patient body mass index did not correlate with flap thickness. The thin and superthin PAP flap has multiple favorable characteristics, making it suitable for extremity reconstruction, and it has become the workhorse skin flap in our institution. Conventional low-frequency CDU together with CTA can be used effectively to map the dominant perforator preoperatively, allowing accurate flap design and rapid flap harvest. Therapeutic Level IV.

Near infrared spectroscopy in monitoring of head and neck microvascular free flaps.

Microvascular free‑flap monitoring is crucial to the early detection of flap failure and increases the chance of early intervention in case of disruption of perfusion to a flap. Many clinical alternatives to classical clinical flap monitoring have been proposed, such as color duplex ultrasonography, handheld Doppler, flap thermometry, or implantable Doppler flowmetry. Early detection of critical changes in tissue oxygenation can lead to successful surgical intervention when problems with flap nutrition arise. Our clinical study seeks to investigate dynamic monitoring of free flaps with near‑infrared spectroscopy (NIRS). NIRS is a non-invasive instrumental technique used for continuous monitoring of peripheral tissue oxygenation (StO2) and microcirculation. All patients were included prospectively from one clinical center. During the clinical research period, 18 patients underwent extraoral head and neck reconstruction with one of three types of free flap, namely with radial forearm free flap (RFFF), anterolateral thigh flap (ALT) or fibula free flap (FFF). Measurements of flap perfusion were taken using NIRS during intraoperative and postoperative phases for 71 hours on average. A total of 6 perfusion disorders were recorded, of which three originated from microanastomoses and three from postoperative bleeding and compression of pedicle. NIRS showed characteristic changes in all 6 cases that were returned to the operating theatre owing to pedicle compromise. In these cases, NIRS had detected the pedicle compromise before it was clinically identified. A single StO2 monitoring was able to detect the vascular compromise with 100% sensitivity and 95.65% specificity. None of the cases were falsely positive. In our study, all compromised flaps were accurately identified by means of NIRS. In most cases, the changes in oxygen saturation became evident on NIRS prior to being clinically observed. In our study, the continuous NIRS monitoring securely detected the early stages of arterial and venous thromboses or pedicle compression. The most important aspects of monitoring the flaps´ microvascular perfusion and vitality by means of NIRS lie in its function of recording the dynamics of changes in the values ​​of absolute oxygen saturation (StO2> 50%) alongside with detecting a 30% decrease in tissue saturation over a 60‑minute interval (60 min StO2 >30%) before the clinical changes in the microvascular flap become observable. In cases of pedicle compression, the average time of appearance of signs of StO2 values dropping below the reference interval (as detected by NIRS) was 1:29:02 hour (SD= 0:58:42 h) prior to the occurrence of any clinical signs, while in cases of microvascular anastomosis complications, it was 0:35:23 hour (SD=0:08:30 h) (SD = 0:08:30 h) (Tab. 3, Fig. 7, Ref. 42).

The Effects of Cigarette Smoking on Venous Flow Volume of Lower Extremity

Aims: The purpose of this study was comparing flow volume rates, velocities and diameters of lower extremity arteries and veins of smokers and non-smokers with peripheral arterial disease. Patients and methods: The study consisted of 58 patients, 26 smokers and 32 non-smokers, who had no smoked for at least 5 years prior to the investigation. Colour Duplex Ultrasonography measurements of the common femoral artery, common femoral vein, popliteal artery, popliteal vein, anterior tibial artery, anterior tibial vein, posterior tibial artery and posterior tibial vein were obtained in the supine position. Differences in the diameters, blood flow velocities, and flow volume rates of the vessels were compared according to the sex, age and Colour Duplex Ultrasonography measurements of the patients. Results: The diameters of the common femoral artery, popliteal vein and posterior tibial artery were statistically significantly reduced in smokers. The flow volume rate of the popliteal artery showed a significant correlation with that of crural vessels in non-smokers but not in smokers. Conclusions: The absence of a statistically significant correlation between the measurements of the popliteal artery and crural vessels in smokers shows that cigarette smoking reduces the diameters and flow volumes of crural vessels, potentially giving rise to impaired tissue perfusion.

Incidence and Predictive Factors of Lower Extremity Deep-vein Thrombosis in Patients with Neurological Diseases in a Sub-Saharan Tertiary Hospital

Background: Deep-vein thrombosis (DVT) is a major cause of morbidity among patients with neurological disease and is implicated in 50%–90% of pulmonary embolisms (PE). Aim: This study aims to identify the incidence and predictive factors of lower extremity (LE) DVT in high-risk neurological patients. Materials and Methods: All patients with neurological diseases who were confined to bed for three days or more, or had elevated D-dimer over a 22 months were included in the study. They all had routine mechanical and chemical prophylaxis. Serial color duplex ultrasonography of the LE was performed for all the patients, and the results were used to stratify them into two groups: DVT positive and DVT negative, and their clinical parameters were recorded and utilised for statistical analysis. Multivariate logistic regression analysis was used to determine the predictive risk factors. Results: A total of 611 patients were admitted, and 107 met the inclusion criteria. The mean age was 57 ± 17 years, with a male-to-female ratio of 1.7:1. Forty-four (41.4%) patients had DVT (overall incidence was 7.2%). Primary intracranial tumours and craniocerebral trauma accounted for 27.2% and 20.5% of aetiology, respectively. The comparative DVT-positive versus DVT-negative group D-dimer levels were 7.9 versus 4.9 mg/L (P = 0.0065), duration of immobility 65.0 versus 35.3 days (P = 0.0001), and length of hospital (LOH) stay 32.5 versus 18.2 days (P = 0.0001). The proximal LE vessels were involved in 64.2%. The PE risk was 0.98%, with three mortalities. The predictive factors on multivariate logistic regression were elevated D-dimers (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.1–4.45 P = 0.030) and preoperative immobility &gt;seven days ([OR] 2.38, 95% [CL] 1.28–4.39 P = 0.042). Gender, C-reactive protein, Glasgow Coma Scale, comorbidities, LOH, and chronic steroid use were not predictive. Conclusion: The overall incidence of DVT and mortality from PE were low among patients with neurological diseases. Most thrombi involved proximal LE veins. Elevated D-dimers and preoperative immobility &gt;seven days were predictive factors for LE DVT.

Great saphenous vein aneurysm mimicking inguinal hernia: a case report

BackgroundDiagnosis of venous aneurysm may be difficult and can be misjudged as mass-like lesions, including hernias. Here we present the case of a patient with a great saphenous vein aneurysm misdiagnosed and operated as an inguinal hernia.Case presentationA 39-year-old Middle Eastern/Persian male presented with left inguinal bulging 15 years ago, which was misdiagnosed and operated on with a diagnosis of inguinal hernia. He was referred to our clinic, in which color Doppler sonography revealed left-sided saphenofemoral junction incompetence with severe flow reversal during the Valsalva maneuver, in favor of a great saphenous vein aneurysm. Ligation of left saphenofemoral junction and stripping of saphenous vein, and stab avulsion phlebotomy of left lower extremity varicose veins, were done. He was discharged the next day after the operation with an uneventful postoperative course or complication on follow-up.ConclusionVenous aneurysms can be misdiagnosed as other, more common, mass-like lesions, such as inguinal hernias. Therefore, our report emphasizes the consideration of thorough assessment and utilization of color duplex sonography to prevent further misdiagnosis and unnecessary intervention and operations.

Predictors of ischemic events in patients with unilateral extracranial vertebral artery dissection: A single-center exploratory study.

ObjectiveExtracranial vertebral artery dissection (EVAD) is one of the main causes of stroke in young and middle-aged patients. However, the diagnosis is challenging. This study aimed to identify the characteristics of EVAD on color duplex ultrasonography (CDU) and high-resolution magnetic resonance imaging (hrMRI), hoping to improve the accuracy and determine the relative contribution of vessel findings and clinical factors to acute ischemic events.MethodsPatients with unilateral EVAD were recruited and divided into ischemia and non-ischemia groups. Clinical features of patients and the lesion location; a variety of signs which indicate dissection, including the presence of an intimal flap, double lumen, intramural hematoma, dissecting aneurysm, intraluminal thrombus, and irregular lumen; and other quantitative parameters of each dissected segment on CDU and hrMRI were reviewed, respectively. Multiple logistic regression was performed to explore the association between clinical, imaging characteristics, and ischemic events in patients with unilateral EVAD.ResultsNinety-six patients with unilateral EVAD who met the inclusion criteria were enrolled during a six-year period. Overall, 41 cases (42.7%) were confirmed as ischemic stroke (n = 40) or transient ischemic attack (n = 1) during the 48 h after the onset of symptoms. Men, infections during the last week, and smoking were more common in the ischemia group. Intraluminal thrombus and occlusion on CDU were more prevalent in patients with cerebral ischemia than in those without (36.6 vs. 5.5%; p < 0.001, and 39.0 vs. 9.1%; p = 0.001, respectively). On hrMRI, intraluminal thrombus and occlusion were also more frequent in the ischemia group than in the non-ischemia group (34.1 vs. 5.5%; p < 0.001, and 34.1 vs. 9.1%; p = 0.003, respectively). In addition, lesion length on hrMRI was significantly longer for patients with ischemia (81.5 ± 41.7 vs. 64.7 ± 30.8 mm; p = 0.025). In multivariable logistic regression analysis, male gender, infections during the last week, and the presence of intraluminal thrombus on CDU and hrMRI were independently associated with acute ischemic events.ConclusionMale sex, infections during the last week, and the presence of intraluminal thrombus due to dissection are associated with an increased risk of ischemic events in patients with unilateral EVAD.

Popliteal Entrapment Syndrome: Diagnostic, Surgical Management, and Short-Term Results of a Ten-Year Experience

Popliteal artery entrapment syndrome (PAES) is a rare cause of lower limb claudication in young sportsperson without cardiovascular risk factor. We reported our diagnostic approach, surgical management, and short-term outcomes of this syndrome, over a 10-year period. Sportsperson with intermittent claudication systematically received color duplex ultrasonography with dynamic maneuvers in the sport medicine department. In case of PAES suspicion, diagnosis was confirmed by dynamic computed tomography or dynamic magnetic resonance angiography. Each patient was then evaluated by a vascular surgeon and surgery was performed. We retrospectively screened patients who underwent PAES surgery between 2010 and 2020 in the Department of Surgery in Angers University Hospital. Between January 2010 and December 2020, 38 patients with 67 symptomatic legs underwent surgery for PAES. Twenty three (60.5%) were men. The mean age at the time of surgery was 24.7 +/- 9years. Clinical presentation was bilateral in 30 patients (81.1%). Duplex ultrasound demonstrated severe stenosis or occlusion in 45 legs (77%). When performed, CT-scan demonstrated popliteal artery compression in all cases (100%). As per Whelan and Rich classification, 36 patients (94.7%) had type 6 PAES. There was no mortality or severe complication after surgery. Morbidity included 4 postoperative hematoma (6%) and 8 prolonged healing (13%). The mean time of follow-up was 2.3months +/- 1.2months. After surgery, D-scan showed no signs of remaining popliteal artery compression in 92.5% of the case. Twelve patients (33.3%) were able to resume sport, 18 (50%) partially, and 6 (16.6%) did not resume sport yet. We report a cohort of 38 patients who underwent surgery for PAES. Among them, 36 (94.7%) were functional PAES. Morbidity included 13% of prolonged healing. Two months follow-up demonstrated good results at dynamic D-scan without signs of remaining popliteal artery compression in 92.5% of the cases. These short-term results showed that one-third of patients were able to resume sport activity at an initial level.

Correlation of Inflammation and Coagulation Markers with the Incidence of Deep Vein Thrombosis in Cancer Patients with High Risk of Thrombosis.

BackgroundDeep vein thrombosis (DVT) is a common complication and the second leading cause of death in cancer patients. Pro-inflammatory stimuli in the cancer microenvironment induce nuclear factor kappa B (NF-κB) signaling pathway that plays an integral role in immunothrombosis mechanism.ObjectiveTo investigate the role of inflammatory and coagulation biomarkers in the development of DVT in cancer patients with high risk of thrombosis (Khorana score ≥2).Subjects and methodsThis study was a cross-sectional study at Dr. Kariadi General Hospital. The serum levels of proinflammatory cytokines, ie, NF-κB, interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and coagulation biomarkers, ie, tissue factor (TF), prothrombin fragment F1+2 (F1+2), fibrinogen and D-dimer were measured in newlydiagnosed cancer patients with a highrisk of thrombosis. Color duplex sonography was used for DVT screening.ResultsFrom January to November 2021, there were 83 eligible patients. DVT was confirmed in 8 subjects (9.63%). Univariate analysis revealed a significant difference between the median age of patients with DVT compared to non-DVT patients, 49.5 years (range: 23–60 years) and 42 years (range: 19–60 years), with p=0.046. D-dimer level was higher in DVT patients [(6.020 µg/L, range 2.090–20.000) vs (1.940 µg/L, range 270–20.000), p=0.005]. Multivariate analysis revealed age and D-dimer were significantly correlated with DVT incidence. In all patients, there were significant positive correlations between several inflammatory and coagulation activation parameters, which were IL-6 with D-dimer and F1+2, CRP with F1+2 and D-dimer as well as TNF-α with F1+2. However, these findings were not shown in DVT patients.ConclusionIn cancer patients with a high risk of thrombosis, age and D-dimer level are the significant variables towards the incidence of DVT. In patients with DVT, there was no significant correlation between inflammatory and coagulation activation parameters.

Glomus-Saving Autografting of the Internal Carotid Artery in the Peracute Period of Ischemic Stroke with Underlying COVID-19

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 is associated with the development of arterial thromboses of different locations. This pathology is common in patients with multifocal atherosclerosis. The overwhelming majority of published reports are devoted to the surgical treatment of patients with thrombosis of lower limb arteries. Thus far, no studies of revascularization in the case of extended atherosclerotic lesion and thrombosis of the internal carotid artery (ICA) in patients with COVID-19, have been published.&#x0D; AIM: To analyze the immediate results of glomus-saving autografting of the ICA with its extended atherosclerotic lesion and thrombosis in the peracute period of ischemic stroke in patients with COVID-19.&#x0D; MATERIALS AND METHODS: The retrospective study (inclusion period 01.01.201701.03.2020) involved 49 patients with hemodynamically significant extended atherosclerotic lesion of the ICA in the peracute period of acute cerebrovascular accident (ACVA). From April 1, 2020, to May 15, 2021, 26 patients with hemodynamically significant extended atherosclerotic lesion and floating thrombus in the ICA and a positive result of polymerase chain reaction to SARS-CoV-2 were included. In all cases, brain revascularization was performed in the peracute period of ACVA in the volume of glomus-saving autografting of the ICA.&#x0D; RESULTS: No adverse cardiovascular events were noted throughout the postoperative follow-up period in both groups. In the examination of the reconstruction zone using color duplex ultrasonography, no data for restenosis/thrombosis were recorded. On day 7 after surgery, in both cohorts of patients, significant regression of neurological deficit on the National Institute of Health Stroke Scale was noted: in the first group, the values during admission and day 7 after revascularization were10.5 3.5 and 6.5 1.5, respectively (р = 0.001); in the second group, the values were 12.5 2.5 and 5.5 1.5, respectively (р = 0.001). In both groups, no cases of unstable difficult-to-control arterial hypertension were noted, and no changes were introduced to the antihypertensive therapy.&#x0D; CONCLUSIONS: Emergency autografting of the ICA with its extended atherosclerotic lesion and thrombosis in the peracute period of ACVA is an effective and safe method of brain revascularization in patients with COVID-19.

Colour Duplex and/or Contrast-Enhanced Ultrasound Compared with Computed Tomography Angiography for Endoleak Detection after Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis.

This study aims to assess the role of Color Duplex Ultrasound with or without contrast media for surveillance following endovascular aortic aneurysm repair (EVAR). A systematic search of the literature published until April 2022 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The pooled rates of endoleak detection through Contrast-Enhanced or Color Duplex Ultrasound (CEUS or CDUS) and Computed Tomography Angiography (CTA) with 95% confidence intervals (CIs) were estimated using random-effect analysis. Thirty-eight studies were considered eligible for inclusion. The total number of patients in the included studies was 5214 between 1997 and 2021. The overall pooled rate of endoleak detection using CDUS and CTA was 82.59% and 97.22%, while the rates for CEUS and CTA were 96.67% and 92.82%, respectively. The findings of the present study support the use of the CEUS for endoleak detection. However, it should be integrated into institutional protocols for EVAR surveillance to further evaluate its clinical utility in the post-EVAR period before it can be recommended as the sole imaging modality after EVAR.

Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series.

PurposeTo evaluate demographic and clinical characteristics of a Chinese population with giant cell arteritis using multimodal imaging focusing on ophthalmic examinations.DesignRetrospective observational case series.Materials and MethodsIn the neuro-ophthalmology division of the Eye, Ear, Nose, and Throat Hospital, Shanghai, we evaluated the demographic and clinical characteristics of patients diagnosed with giant cell arteritis between January 2016 and June 2021. Results of routine ophthalmic examinations including fundus examination, optical coherence tomography, color duplex ultrasonography of ocular and superficial temporal arteries, orbital magnetic resonance imaging, and superficial temporal artery biopsy were evaluated.ResultsA total of 15 patients (22 eyes; ten male and five female) were evaluated with a mean age of 77.0 ± 8.5 years. Among them, seven had bilateral involvement that occurred simultaneously or sequentially. Twelve patients presented with arteritic anterior ischemic optic neuropathy, two with arteritic anterior ischemic optic neuropathy combined with cilioretinal artery occlusion, and one with cotton-wool spots. In acute stages of optic neuropathy and retinopathy, optical coherence tomography revealed optic disc edema, thickening of the inner retinal nerve fiber layer and ganglion cell layer, and loss of layer structure. In late stages, optical coherence tomography revealed diffuse atrophy of the inner retina. The “halo” sign was observed in 12 patients in the superficial temporal artery ultrasound, and seven out of eight patients who underwent biopsy demonstrated classic giant cell arteritis pathological changes. Most patients having poor visual acuity but ability to perceive light; 10/22 eyes had permanent vision loss.ConclusionAlthough rare in Asians, giant cell arteritis may be underdiagnosed among elderly Chinese patients presenting with anterior ischemic optic neuropathy. Non-invasive superficial temporal artery ultrasound detecting inflammatory thickening of the intima as the “halo” sign combined with routine elevated erythrocyte sedimentation rate and C-reactive protein may be helpful in diagnosing patients with a high probability of having giant cell arteritis.

Correlation of Multidetector Computed Tomography Peripheral Angiography with Color Duplex Sonography in Peripheral Arterial Disease.

With aging of the global population peripheral arterial disease is increasingly common. Arteriography, computed tomography angiography and magnetic resonance angiography are common modalities used for evaluation of peripheral arterial disease. However, they have limitations of being invasive, costly, limited availability or contraindicated in patients with renal impairment or contrast allergy. Duplex imaging, a method of evaluation of peripheral arterial disease is cost effective, widely available and safe even in patients with renal impairment and contrast allergy. A prospective cross sectional descriptive study involving 114 patients was conducted from November 2015 to October 2016. The patients were evaluated by Doppler ultrasound following multi-detector computed angiography in Department of Radiology, Tribhuvan University Teaching Hospital. The lower limb arteries were divided into 10 segments and stenosis or occlusion of each segment in Computed Tomography angiography were compared with findings in Doppler, Computed Tomography angiography being considered the gold standard. Data was collected in predesigned proforma in Microsoft Excel spread sheet. Duplex imaging showed sensitivity 94.94%, specificity 98.54%, accuracy 97.54%, positive predictive value 96.15 % and negative predictive value 98.06 %. In assessment of 22 segments, partial stenosis seen in Computed Tomography angiography was overestimated as complete stenosis in Doppler. There was significant positive correlation of velocity ratio with degree of partial occlusion (r=0.918 for right lower limb and r=0.895 for left lower limb, p <0.01). Duplex imaging is safe cost effective and reliable method of evaluation of patients with peripheral arterial diseases.

Open resection for a large iatrogenic radial artery pseudoaneurysm. Case report.

Introduction and importanceWe present the case in which a large symptomatic pseudoaneurysm (PSA), 6 × 5 cm, with one year of evolution on the path of the right radial artery (RRA) appeared after its punction and cannulation for performing cardiac catheterism in an atrial fibrillation (AF) indefinite anticoagulated patient. Diagnosis and surgical planning were consolidated only by using color duplex ultrasound (CDU), contrasted images were not indicated.The open surgical management was performed during a short-time supraclavicular blockade of peripheral nerves without stopping nor bridging anticoagulant therapy. Complete excision of the deforming mass with no blood loss, decompression of the adjacent structures and direct closure of the arterial defect without compromising of its lumen and path were also achieved.Case presentationA 74-year-old, Hispanic male patient and former smoker underwent coronary catheterization for thoracic typical pain. One year after, he is admitted for move restrictive pain in distal right forearm and hand paresthesia related to a rapidly growing right radial artery PSA of 6 cm in diameter where the indefinite anticoagulation, indicated for chronic AF, confers a risk of major bleeding.After clinic and exclusive CDU assessing, the patient granted us written authorization for performing an open surgery.One year follow up showed an asymptomatic patient with no RRA residual lesions.Clinical discussionAlthough contrasted are the preferred diagnosis methods when arterial issues are suspected especially angiography since, when indicated, the endovascular treatment may be performed immediately after diagnosis. The CDU performed with a high-sensitivity transducer is the image of choice for an immediate differential diagnosis (Meola et al., 2021 [1]). In addition, it allowed us to see both, the particular PSA inside structure and the patency of ipsilateral ulnar artery, necessary details to propose the successful open surgical treatment finally conducted.ConclusionVascular and trauma surgeons should be trained to ensure the correct diagnosis based on preexisting medical conditions, clinical findings and those provided by CDU in order to offer an appropriate and definitive management to peripheral vascular iatrogenic lesions with potential bleeding risk, especially in anticoagulated patients. Since large limb deforming PSAs are recommended to be excided through open access, they should also be trained to perform it without additional risks nor sequelae.Since the number of AF patients is increasing worldwide, main aspects on anticoagulation therapy have to be taught to every surgical team.

Diagnostic use of ultrasound in giant cell arteritis in Counties Manukau District Health Board, New Zealand.

ObjectivesA retrospective observational study was undertaken to assess the diagnostic performance (sensitivity and specificity) of colour duplex ultrasound (CDUS) compared with temporal artery biopsy (TAB) for the diagnosis of GCA in the Counties Manukau District Health Board (CMDHB), New Zealand using clinical diagnosis as the reference standard.MethodsThe study population included patients with clinically suspected GCA who were referred to Middlemore Hospital and underwent CDUS, TAB or both between January 2019 and December 2020.ResultsSixty-nine patients were included in the study. Sixty-one percent were >75 years of age, with no cases <50 years of age and a female predominance of 71%. The sensitivity of CDUS was 26% (95% CI 10, 48) and specificity was 97% (95% CI 84, 100). The sensitivity of TAB was 57% (95% CI 34, 77) and specificity was 100%. CDUS had a positive predictive value of 86% (95% CI 42, 99) and a negative predictive value of 65% (95% CI 49, 78).ConclusionA positive CDUS in patients with a high risk for GCA may preclude the need for TAB due to the high specificity of CDUS in GCA. In contrast, patients with a high risk for GCA with a negative CDUS may still need TAB to confirm or exclude GCA. The duration from commencement of steroids to the time of CDUS is crucial in confirming GCA and, for this, shortening the waiting time in the CMDHB would be necessary to ensure adequate test performance in practice.

An Unorthodox Vascular Surgical Approach to Save a Limb

A 33 year old male intravenous drug user was referred urgently with right groin haemorrhage and acute limb threatening ischaemia after superficial femoral artery (SFA) puncture. A ruptured SFA pseudoaneurysm was detected by colour duplex ultrasonography. Young age, synchronous presence of abscess (Pseudomonas aeruginosa isolates), extensive tissue damage, and lack of appropriate venous conduit favoured an end to end anastomosis (A and B, asterisk) of the profunda femoral artery (PFA) to the distal SFA stump. Meropenem was administered for 21 days and a vacuum assisted closure device helped with wound healing. Using this provocative technique, successful revascularisation and lower limb salvage were achieved.Image 1