Color Duplex Sonography Research Articles

Ischaemic heart disease in patients with diabetes mellitus and critical lower limb ischemia

Aims. To assess prevalence of ischemic heart disease (IHD) and clinical features of asymptomatic IHD in patients with diabetes mellitus(DM) and critical lower limb ischemia (LLI).Materials and Methods. We examined 118 patients with DM, who underwent hospitalization for critical LLI. Besides routinecardiologic examination, all patients were subject to color duplex ultrasonography of lower limbs and CT contrast angiography. Patientswith proper indications underwent coronary angiography. Statistical data was processed with SPSS v17.0.0. software package. Results. We have found 58.5% of patients with DM and critical LLI to suffer from IHD - and approximately 40% to have myocardialinfarction in their medical history. According to acquired coronary angiograms, 89% of asymptomatic cases were characterized byhemodynamically significant stenosis, while 68.7% of them had either three arteries affected or left main coronary artery lesions. Conclusion. Patients with DM and critical LLI require thorough examination, as subclinical IHD may be masked in them by lowerlimb angiopathy.

Dr. Czihal replies: Figure 1.

To the Editor: We appreciate the comments from Milchert, et al 1 on our study evaluating the involvement of femoropopliteal arteries in giant cell arteritis (GCA)2. In their letter, they describe 2 cases with different clinical manifestations of extracranial GCA, including 1 patient with suspected vasculitis of the lower extremities. They discuss the difficulties in discriminating between vasculitis and arteriosclerosis in clinical practice. Detection of a homogenous, hypoechogenic, circumferential vessel wall thickening by color duplex sonography (CDS) has been shown to be specific for …

320 CORRELATION BETWEEN CAROTID ULTRASOUMD AND EXERCISE STRESS TEST FOR ASSESSING THE SUBLINICAL VASCULAR DESEASES IN HYPERTENSIVE PATIENTS

Aim: The relationship between carotid pathology and exercise stress – test (EST) in patients with new onset symptoms for cardiovascular disease (CVD) as predictor for cardiovascular events1,2. Material and methods: EST and echocardiography were performed in 503 patients (mean age 54±17,5y, men 64%) with typical and untypical symptoms for CVD and classified in three groups- with positive, negative and questionable results. Color duplex sonography was performed and intima media thickness (IMT) of the common (CCA) and the internal carotid arteries was measured. No modifiable (age and sex) and some modifiable (hypertension, diabetes, atrial fibrillation, dyslipidemia, carotid artery stenosis, obesity)- FR were evaluated. Results: AH was the most common RF in all groups–75 %,dyslipidemia-64 %,diabetes-28 %. A symmetrical LV hypertrophy and a decrease of its contractility, as E/E’>15 was found as typical diastolic dysfunction. Mild stenosis of ICA(35%) predominated in all groups while moderate (36–55%) or severe(>60%) - were relatively rare, especially with positive EST. Symptomatic thromboses of ICA were seen in 4,5 % pts with positive EST. IMT of the ICA correlated positively with the arterial blood pressure (r=+0.60,p<0.05).A positive correlation was established between CCA, diastolic blood flow and EF in all patients groups (r=0.45;p<0.01). In group with positive EST (32%) were found significant carotid disease (28%) and significant coronary anatomy. The multivariable analysis confirms that AH, positive ESTs and questionable ESTs correlated very fair with moderate and mild carotid pathology and significant coronary diseases in pts with positive ESTs (beta 0.31;p<0.001). Conclusion: The study confirms clinical impact of carotid pathology alone or its association with other RF is under consideration. Carotid ultrasound in patients with CVD and AH is sensitive method for assessment of coronary pathology. References Kanwar M, Rosman HR, Fozo PK, Fahmy S, Vikraman N, Gardin JM, Bess RL,Cohen GI. Usefulness of carotid ultrasound to improve the ability of stress testing to predict coronary artery disease. Am J Cardiol 2007;99:1196 –1200. Honda O, Sugiyama S, Kugiyama K, Fukushima H, Nakamura S,Koide S, Kojima S, Hirai N, Kawano H, Soejima H, et al. Echolucent carotid plaques predict future coronary events in patients with coronary artery disease. J Am Coll Cardiol 2004;43:1177–1184.

Arteriosclerosis or Vasculitis? Color Duplex Sonography in Giant Cell Arteritis

To the Editor: We followed with great interest the report by Czihal, et al 1 presenting new possibilities of objective, noninvasive diagnostic procedures that remain insufficient in giant cell arteritis (GCA). We would like to share our clinical experiences with arteritic changes in patients with GCA. Sonographic presentations of vasculitis may be mistaken for arteriosclerosis, especially in elderly patients who typically have GCA. That was the case in a patient with mild systemic manifestations and insidious disease onset. A 64-year-old woman presented with carotidynia — a rare manifestation of GCA. Color duplex sonography (CDS) revealed hypoechoic, homogenous, circumferential but not symmetrical bilateral wall thickening involving carotid and internal carotid arteries up to 15 mm from the carotid … Address correspondence to Dr. Milchert; E-mail: marcmilc{at}hotmail.com

Systematic review of the literature and a case report informing biopsy-proven giant cell arteritis (GCA) with normal C-reactive protein

Giant cell arteritis (GCA) is a vasculitis of large- vessels. A markedly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are characteristics of GCA, although temporal artery biopsy remains the gold standard for the diagnosis. We describe a case of biopsy-proven GCA showing a heavy infiltration of CD68 macrophages and CD3 T cells and with normal ESR and CRP levels at diagnosis. Key points (1) GCA may occur with normal ESR in a percentage of about 4 to 15 % (although the American College of Rheumatology classification criteria for giant cell arteritis include an ESR of 50 mm/h or more), while it can occur with normal ESR and normal CRP in a percentage of about 0.8 %. So, the clinical suspicion must be confirmed with a positive biopsy. (2) GCA patients with ESR >40 mm/h are characterized by higher incidence of headache and jaw claudication compared to patients with normal ESR. In our case, it occurred with normal ESR. (3) Color duplex ultrasonography is a noninvasive, easy, and inexpensive method for supporting a diagnosis of TA, with a high sensitivity and specificity. It can predict which patient will need TAB.

Perforation der A. carotis communis als Ursache eines Halsgefäßscheidenhämatoms

Perforation of the carotid artery is a rare, life-threatening emergency. This entity is usually caused by failed puncture of jugular veins, external trauma, or infection of the vascular wall. The existence of spontaneous rupture as a cause of vessel rupture is discussed in the literature. The case of a 57-year-old woman who suffered painful cervical swelling on the left side for 2 days is described. Six weeks prior to this, she had received transjugular intrahepatic shunt implantation (TIPS) via the jugular vein because of liver cirrhosis. Further signs were vocal cord dysfunction and Horners' syndrome on the left side. Computed tomography (CT) with contrast agent revealed a huge mass surrounding the common carotid artery. Differentiation between a solid tumor and carotid dissection was primarily not possible. Radiological considerations also comprised an abscess or even a paraganglioma. Only color duplex sonography revealed a pendular blood flow slightly caudal of the carotid bifurcation. In agreement with the CT findings, a calcified plaque appeared directly downstream of the presumed vessel injury. Operative revision was performed in collaboration with the vascular surgeon. Transluminal endarteriectomy and vessel reconstruction with patch plasty was performed. Cervical hematoma caused by carotid injury of unknown origin is a rare differential diagnosis of sudden cervical swelling. In this case, failed venous puncture in conjunction with pre-existing arterial plaque and therewith inflammation of the vessel wall could have caused the injury and delayed carotid rupture.

Temporal Artery Compression Sign - A Novel Ultrasound Finding for the Diagnosis of Giant Cell Arteritis

In patients with suspected giant cell arteritis (GCA), a search for the perivascular halo sign, a sophisticated color duplex ultrasound (CDU) finding, at experienced centers reliably identifies inflamed temporal arteries (TA). We tested whether TA compression in patients with GCA, a simple, largely operator-independent maneuver, elicits contrasting echogenicity between the diseased artery wall and the surrounding tissue (compression sign). 80 individuals with suspected GCA were prospectively enrolled in this single-center study. In all study participants, bilateral ultrasound examination of the TA established the presence/absence of the halo and compression sign. A positive compression sign was defined as visibility of the TA upon transducer-imposed compression of the artery. Based on ACR criteria, a team of specialized physicians independently grouped patients as GCA versus non-GCA. 43/80 study participants were grouped as GCA. Both the halo sign and the compression sign were positive in 34/43 patients in the GCA group, and negative in all 37/37 of the non-GCA group, resulting in a sensitivity of 79 % and a specificity of 100 % for both the halo and the compression sign. In this cohort of individuals with suspected GCA, the halo sign and the compression sign were equal in their diagnostic performance. The simplicity of the compression sign suggests a level of reliability warranting further evaluation.

Extracranial Color Duplex Sonography as a First Tool in the Prognosis after Thrombolytic Therapy

Extracranial Color Duplex Sonography as a First Tool in the Prognosis after Thrombolytic Therapy

Evaluation of disease activity in ankylosing spondylitis; diagnostic value of color Doppler ultrasonography

Spondyloarthropathies including ankylosing spondylitis (AS) require early diagnosis to prevent irreversible changes. Sacroiliitis is a common initial manifestation of AS and is frequently diagnosed by magnetic resonance imaging (MRI). The goal of our study was to assess color Doppler ultrasonography as a potential diagnostic tool in suspected sacroiliitis in comparison with MRI representing the gold standard. Fifty-one consecutive patients with AS and sacroiliitis and 30 control subjects underwent contrast-enhanced MRI and high resolution color Doppler and duplex ultrasonography of both sacroiliac joints (SIJ) for the detection of vascularization and blood flow spectral Doppler waveform analysis. MRI demonstrated active disease in 27 and inactive disease in 24 patients. CDUS detected pulsatile monophasic wave spectral waveform flow in 22 patients with the active disease, and triphasic in 7 patients with inactive disease and in 8 control patients. The sensitivity, specificity, positive predictive value and negative predictive value for active sacroiliitis detection with CDUS were 82 % (95 % CI, 68-91 %), 92 % (95 % CI, 85-96 %), 91 % (95 % CI, 84-96 %), and 84 % (95 % CI, 70-92 %), respectively, for pulsatile monophasic wave spectral waveform Doppler sonography. MRI of SIJ was negative in all 30 (60 SIJ) control participants. Our results show that CDUS is a practical and useful tool in the diagnosis of active sacroiliitis.

Brain tissue perfusion monitoring using Sonopod for transcranial color duplex sonography

We have introduced and improved a transducer holder, named the Sonopod, for transcranial color duplex sonography (TCDS) monitoring via both temporal/foraminal windows (TW/FW). The objective is to clarify clinical usefulness and identify problems in TCDS-Sonopod monitoring during the evaluation of brain tissue perfusion. Brain tissue perfusion monitoring was evaluated in 11 patients (ages 31–94, mean 66). After a bolus intravenous Levovist ® , power modulation imaging (PMI) in all cases was evaluated in comparison with second harmonic imaging (SHI) in two cases at the diencephalic horizontal plain via the TWs on the basis of time–intensity curves (TICs) in five regions of interest (ROIs); bilateral basal ganglia (BG) and thalamus (Th), and contra-lateral temporal lobe (TL). After a SONOS5500 S3 transducer was installed in the Sonopod, acetazolamide (ACZ) cerebral vasoreactivity utilizing PMI was evaluated in 10 cases via the bilateral (five cases) and unilateral (five cases) TWs. A total of 30 TICs were evaluated before/after ACZ administration. (1) All patients could be monitored continuously by one examiner. (2) We confirmed that PMI proves superior to SHI in quantitative evaluation of the bilateral hemispheres via the unilateral TWs. (3) Brain tissue perfusion could be precisely quantified before/after ACZ in the same ROIs. (4) TIC base-line drifts during monitoring were observed in 4 (seven TICs) of 10 (30 TICs) patients. However, fixed-probe shifts during monitoring were easily readjustable and the TIC recovered to the base-line in all cases. (5) Due to re-fixation needed for contralateral TW monitoring, it was not possible to evaluate completely in the same ROIs. TCDS-Sonopod monitoring succeeds in continuously and quantitatively evaluating precise and reproducible intracranial hemodynamics in the brain tissue.

Evaluation of Parotid Gland Lesions with Standard Ultrasound, Color Duplex Sonography, Sonoelastography, and Acoustic Radiation Force Impulse Imaging – a Pilot Study

To evaluate the impact of standard ultrasound (US), color duplex sonography (CDS), sonoelastography (SE), and acoustic radiation force impulse (ARFI) imaging in the differentiation of parotid gland lesions. From September 2010 to February 2011, 33 parotid gland lesions of 32 patients were included in this study. Patients underwent high-resolution B-mode US (THI, 9 - 14 MHz), CDS, SE, and ARFI quantification. Then parotidectomy was performed and samples were analyzed by (immuno-) histology. Data was extracted via unpaired t-test and expressed in p-values. There were 12 Wathin's tumors (WT), 11 pleomorphic adenomas (PA), 3 other benign tumors, 3 ductal dilatations, 2 neuroendocrine carcinomas, 1 non-Hodgkin lymphoma, and 1 malignant melanoma metastasis. In B-mode US, acoustic enhancement showed statistical significance between PA and WT (p < 0.005), and CDS determined different vascularization patterns (p < 0.0005). While SE did not visualize any significant difference between PA and WT, ARFI quantification determined different mean values for both entities (p < 0.003). B-mode US, CDS, and ARFI quantification distinguish PA from WT. The predictive value of the modern techniques for the differentiation of benign and malignant parotid lesions has to be assessed in a larger series.

Association of asymptomatic hyperuricemia and endothelial dysfunction in psoriatic arthritis

IntroductionCardiovascular disease is an increasingly recognized contributor to excess morbidity and mortality in psoriatic arthritis (PsA). Traditional cardiovascular risk factors do not adequately account for the extent of cardiovascular disease in PsA. Aim of the workTo examine the prevalence of subclinical atherosclerosis in patients with PsA to emphasize the potential role of serum uric acid on endothelial dysfunction, as an early predictor for atherosclerosis in PsA patients. Patients and methodsThis study included 60 PsA patients as well as 60 age and sex matched healthy controls. Assay of serum uric acid, interleukin-6 (IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) was done for all patients and controls. Patients were subjected to psoriasis area severity index (PASI) and assessment of disease activity. Patients and controls underwent brachial flow-mediated dilatation (FMD) assessment by color duplex sonography to determine endothelial dysfunction as well as extracranial carotid arteries assessment by high-resolution B-mode ultrasound to measure the common carotid intima-media thickness (CIMT) and the detection of atheromatous plaques. ResultsPsA patients have a high significant difference in CIMT, FMD of the brachial artery and mean levels of serum uric acid compared to healthy controls (p<0.001). PsA patients with hyperuricemia have a high significant difference in CIMT and FMD of the brachial artery than those with normal serum uric acid. Serum uric acid levels showed a high significant positive correlation with each of CIMT, disease duration, markers of inflammation (ESR, CRP, IL-6, sICAM-1), disease activity score in 28 joints (DAS 28) and PASI (r=0.71, 0.893, 0.956, 0.858, 0.853, 0.877, 0.907, 0.847, respectively, as p<0.001). A high significant negative correlation was found between serum uric acid levels and FMD of the brachial artery as r=−0.634, p<0.001. ConclusionPatients with PsA have a high prevalence of subclinical atherosclerosis dependent on serum uric acid, suggesting that chronic systemic inflammation and endothelial dysfunction appear to be the link between asymptomatic hyperuricemia and atherosclerosis. Therefore, proper control of serum uric acid may play a preventive role in the development of atherosclerosis in PsA patients.

The role of color duplex sonography in the brain death diagnostics

Summary In Russia brain death diagnostic is still under great public attention. In such environment confirmatory tests are absolutely necessary. Aim of our study is to investigate the cerebral blood flow in brain death using color-coded duplex sonography. The sonographic study of 20 patients with brain death was performed and included transcranial and extracranial color duplex sonography. All patients were untrepanized. The following parameters were measured – presence of reverberating flow, Vmax ranges. Results : At baseline TCDS revealed both MCA in all patients, and the BA in 18 patients. Oscillating flow with Vmax −32 ± 12 sm/s in MCA was found. Reverberating flow in the proximal segment of ICA and in the V2 segment of VA was found in all patients. Vmax ranges were 96 ± 27 sm/s in ICA and 58 ± 17 sm/s in VA. After 6 h TCDS was successful in 16 patients. In all of 16 cases blood flow in the MCA as a systolic peak or reverberating flow was detected. Basilar system study was successful in 12 cases. In all vessels blood flow was as systolic peaks. Extracranial ICA and VA were visualized in all cases. In the ICA and V2, V3 segments of the VA reverberating flow were detected. Vmax was 47 ± 25 sm/s in ICA and 35 ± 17 sm/s in VA. In BD color duplex scanning reveals oscillating flow or systolic spikes in distal ICA, VA, intracranial vessels. In TCDS, the most common finding is MCA with reverberating flow. The optimum combination is extracranial and intracranial scanning in the early stages of BD.

The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap

The anterolateral thigh (ALT) flap has become a workhorse in reconstructive surgery of the head and neck region and the extremities. However, its inconsistent vascular anatomy and frequent intramuscular course of perforators often cause difficulties during the dissection of this versatile flap. Hence, reliable preoperative perforator mapping and identification of vascular anomalies may render the raising of the flap easier and safer. The aim of this study was to evaluate the use of Color Duplex sonography and whether it allows the distinction between septocutaneous and musculocutaneous perforators. For this purpose, the thighs of 13 patients undergoing reconstruction with ALT flaps were examined preoperatively, and results were compared to intraoperative findings. A total of 30 perforators could be detected preoperatively, of which 29 were confirmed during flap dissection. Preoperative Color Duplex sonography correctly predicted the course of all perforators as either running through the vastus lateralis muscle or the intermuscular septum. In our investigations, Color Doppler sonography had a 96.7% positive predictive value and a 96.7% true positive rate in detecting perforators. Color Duplex sonography is a highly reliable tool in the preoperative assessment of ALT flaps. Localization and course of perforators can be determined accurately and vascular anomalies can be identified.

Sonographic and clinical pattern of extracranial and cranial giant cell arteritis

Objectives: The aim of our study was to describe the sonographic pattern and clinical manifestations of extracranial (i.e. carotid and proximal arm arteries) and cranial arterial involvement in patients with giant cell arteritis (GCA).Methods: One hundred and ten consecutive patients with an established diagnosis of GCA between January 2002 and June 2010 were identified retrospectively from a database. All patients underwent colour duplex sonography (CDS) of the superficial temporal, carotid, and proximal arm arteries at the time of diagnosis. Circumferential, homogeneous, hypoechogenic wall thickening was regarded as a typical sign for GCA. Sonographic and clinical characteristics of patients with and without extracranial vessel involvement were compared.Results: Extracranial GCA was observed in 59 of 110 subjects (53.6%). The axillary artery (48.2%) was most frequently affected and bilateral vessel involvement was present in almost all patients (94.8%). Compared to patients with cranial GCA, patients with extracranial GCA were significantly younger, frequently did not meet the American College of Rheumatology (ACR) criteria for classification of cranial GCA, exhibited a lower rate of permanent visual impairment, and were diagnosed later after onset of clinical symptoms (all p < 0.01). With increasing age, a continuous shift from GCA with extracranial arterial involvement to cranial GCA was observed.Conclusion: Using CDS, extracranial GCA is a common finding, most frequently observed in the axillary arteries. The clinical pattern of GCA with extracranial arterial involvement differs from that of cranial GCA.

Involvement of the Femoropopliteal Arteries in Giant Cell Arteritis: Clinical and Color Duplex Sonography

To determine the extent and clinical significance of giant cell arteritis (GCA) of the femoropopliteal arteries. This was a retrospective clinical color duplex sonography (CDS) study; 60 of 112 consecutive patients with the diagnosis of GCA underwent complete clinical examination of the lower extremities including the vasculature, systolic ankle pressure measurement, and CDS scans of the femoropopliteal arteries within 1 year after diagnosis of GCA. Circumferential, hypoechogenic, homogenous wall thickening was regarded as a hallmark of femoropopliteal GCA. GCA of femoropopliteal arteries was present in 32 (53.3%) of 60 patients. In general, femoropopliteal GCA developed bilaterally (100%) and 14 patients (23.3%) had significant lower extremity artery obstructions secondary to vasculitis, all leading to symptomatic lower extremity ischemia, with development of critical leg ischemia in 4 patients. Compared with subjects without lower extremity vasculitis, patients with femoropopliteal involvement had a significant time delay until diagnosis (mean 23.9 vs 11.1 weeks; p = 0.03) and a higher frequency of concomitant vasculitis of the arm arteries (74.2% vs 42.9%; p = 0.02). Femoropopliteal artery involvement appears to be a clinically relevant manifestation of GCA, frequently leading to symptomatic lower extremity ischemia. CDS of the femoropopliteal arteries is a noninvasive diagnostic tool for detection of lower extremity vasculitis in GCA.

Role of color duplex sonography in pre-operative internal mammary artery perforators assessment for breast reconstruction using contralateral lower pole flap

Reconstruction of a breast after mastectomy using the contralateral lower pole breast flap is an appealing procedure because it uses the tissues that were going to be excised during reduction of the sound breast to achieve symmetry. The literature mentioned that these flaps are supplied by the lower internal mammary artery perforators (IMAPs) with no further details.The aim of this study was to determine the site, size and number of the 4th and 5th IMAPs by using preoperatively color Duplex ultrasound and to assess its accuracy with intraoperative exploration. Twenty breasts in ten patients who presented for reduction mammoplasty were included in this study. Preoperative color Duplex ultrasound determined IMAPs in the 4th and 5th intercostal spaces. Intraoperative localization of these perforators assured the accuracy of the color Duplex. Statistically, the 4th IMAP diameters were significantly larger than the 5th IMAP diameters (P<0.05). The study concluded that color Duplex ultrasound is an accurate tool to preoperatively determine the 4th and 5th IMAPs.

Delayed appearance of hypaesthesia and paralysis after femoral nerve block

We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible.

Our Experience with Carotid Body Paragangliomas

Carotid body paragangliomas (CBP) are rare neoplasms arising from the small chemoreceptor organ in the adventitia of the common carotid bifurcation. The aim of this study is to present the diagnostic process, performed treatment and obtained results in patients with carotid body paragangliomas of the Department of Otolaryngology of Istanbul Education and Research Hospital between March 1997 and November 2008. Retrospective analysis was carried out, based on the medical documentation of 5 patients with carotid body paragangliomas (3 women and 2 men), age range 44 to 68 years with a mean of 59.6 years. Four of the patients were diagnosed and treated with Shamblin type II tumor, one of the patients with type I. Physical examination, radiological evaluation, method of the treatment and post-treatment complications were studied. The most common and single symptom was nonspecific neck mass. Preoperative diagnostic evaluation consisted of a color duplex ultrasonography, computerized tomography with contrast enhancement, magnetic resonance imaging and digital subtraction angiography. In all patients with Shamblin type I and II, blunt dissection of the tumor was conducted smoothly in the subadventitial plane. Postoperative vagus nerve and hypoglossal nerve deficit were reported in one case. Carotid body paraganglioma excision has higher risk of cranial nerve paresis and carotid artery injury, so it requires careful handling and good surgical skills to ensure complete removal.

Ulnar artery occlusion is predictive of digital ulcers in SSc: a duplex sonography study

To assess the prevalence and risk factors of ulnar artery occlusion (UAO) in an unselected SSc patient cohort and to determine whether UAO is associated with digital ulcers (DUs). A total of 79 SSc patients and 40 'healthy' controls underwent colour duplex sonography of the radial and ulnar artery to compare blood flow velocity, resistive indices (RIs) and presence of occlusion and were followed for a mean of 53 months. In both, radial and ulnar arteries, peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly lower and RI higher in SSc patients compared with controls (PSVrad: 40.1 vs 48.6 cm/s; PSVuln 38.2 vs 56.6 cm/s; EDVrad 3.8 vs 10.4 cm/s; EDVuln 3.0 vs 13.0 cm/s; RIrad 0.91 vs 0.82; RIuln 0.92 vs 0.80; all P < 0.01). Seventeen (21.5%) SSc patients had UAO (11 patients bilateral) compared with none in the control subjects. Patients with UAO had a significantly longer disease duration (170 vs 66 months, P < 0.001). At baseline, the prevalence of DU was not different in upper extremities with UAO [8/28 (28.6%)] compared with upper extremities without UAO [36/129 (27.9%)]. However, during follow-up new or recurrent DU occurred more often in upper extremities with UAO than in those without UAO [14/28 (50%) vs 24/113 (21.2%); relative risk (RR) = 2.4; 95% CI 1.4, 3.7; P = 0.002]. Blood flow is significantly decreased in radial and ulnar arteries in SSc. UAO is frequent and an important risk factor for the development of DUs in patients with SSc.