Duplex Ultrasound Research Articles

Diagnostic Value of Maximal Systolic Acceleration Measurements in the Follow-up of Complex Endovascular Aortic Repair: Illustration of a Concept

Purpose: After complex endovascular aortic repair (cEVAR), long-term surveillance is advocated to monitor for potential (stent-related) complications. Although various imaging modalities are used, computed tomography angiography remains the standard in current clinical practice worldwide. However, radiopaque markers can cause metal artifacts and scattering, hampering assessment of patency of side branches. The maximal systolic acceleration (ACCmax) is a relatively new duplex ultrasound (DUS) parameter measured distal to a stenosis, avoiding in-stent assessment and scattering. The aim of this article is to illustrate the potential diagnostic utility of the ACCmax after cEVAR and visceral artery stenting in general. Technique: The ACCmax is measured at the maximal slope of the upstroke during the systolic phase in arterial flow. By manually connecting 2 points, a tangent line is created in which the maximal acceleration is automatically calculated and expressed in m/s2. A higher value reflects better arterial perfusion proximal to its measurement point. One measurement of a visceral artery takes about 5 minutes. Conclusion: ACCmax measurements can be a useful addition during DUS follow-up after cEVAR or visceral artery stenting, possibly decreasing radiation exposure, nephrotoxicity, and health care costs. Clinical Impact Long-term surveillance after complex endovascular aortic repair (cEVAR) is necessary to monitor for potential (stent-related) complications. Although CTA is the most common modality for imaging, metal artifacts and scattering can hamper the assessment of stent patency. The maximal systolic acceleration (ACCmax) is a duplex ultrasound based parameter that reflects arterial perfusion proximal to its measurement point. Due to its noninvasive nature, it can be a useful addition during follow-up after cEVAR or visceral artery stenting, possibly decreasing radiation exposure, nephrotoxicity and health care costs as well.

Case report of varicose veins treatment in patient with a prosthetic mitral valve

This clinical case may be of interest in situations where a patient with varicose veins of the lower limbs and concomitant heart disease, who is on long-term anticoagulant therapy and is scheduled to undergo minor surgery, may present the possibility of endovenous laser ablation (EVLA) against the background of warfarin use. Patient, G., 68 years old, with rheumatic combined mitral valve disease (mitral valve replacement in 2019, permanent atrial fibrillation), also had varicose vein disease of the lower limbs. History included acute cerebrovascular accident (19.01.2023). Duplex Ultrasonography Screening (DUS) showed failure of the left great saphenous vein valve. Hypocoagulation was also observed in coagulogram and the risk of bleeding on HAS-BLED score was average. On Caprini score, the risk was very high. Endovenous laser ablation of the large saphenous vein on the left side was performed. During follow-up examinations, there were no signs of bleeding from puncture sites. The target trunk was obliterated in dynamics at DUS. Therefore, it is possible to carry out EVLA of a large subcutaneous vein while taking therapeutic doses of warfarin without switching to bridge therapy. Endovascular laser ablation allowed it to be done with less risk of bleeding and, against the background of taking warfarin, reduced the risk of thrombosis.

Evaluation of cerebral autoregulation in dogs via transcranial color-coded duplex sonography and transient hyperemia testing.

To evaluate the changes in flow velocities of the middle cerebral artery before and after a carotid compression maneuver using transcranial color-coded duplex sonography (TCCD) in healthy anesthetized dogs under mechanical ventilation. Prospective study. University teaching hospital. Eleven healthy adult dogs. A 5-second carotid occlusion maneuver was performed to evaluate cerebral autoregulation (CA). After 10minutes of stable anesthesia, the middle cerebral artery was evaluated by TCCD. Dogs were positioned in sternal recumbency with the head raised to the level of the phlebostatic axis. The systolic peak velocity (Vp) was measured using pulsed Doppler mode. CA was evaluated through the transient hyperemia test (THT), which assesses changes in the Vp after a 5-second transient compression of the ipsilateral common carotid artery and is expressed as the ratio between the Vp flow before and after carotid compression. The Vp before and after carotid occlusion was compared using the Wilcoxon signed-rank test. The median Vp of the middle cerebral artery after the carotid compression maneuver was significantly higher than the median Vp before compression (median [interquartile range, IQR]: 47.7cm/s [34.3]vs64.1cm/s [24.4]; P=0.003). The median THT obtained was 1.20 (IQR: 0.37). The current study demonstrated a significant increase in the Vp of the middle cerebral artery after a 5-second temporary occlusion of the ipsilateral carotid artery in healthy anesthetized dogs under mechanical ventilation. These findings suggest that the noninvasive TCCD methodology could be valuable for assessing CA in dogs. Additional studies using this technique in neurocritical animals are required to confirm its usefulness.

Changes in portal pulsatility index induced by a fluid challenge in patients with haemodynamic instability and systemic venous congestion: a prospective cohort study

BackgroundIt is uncertain whether fluid administration can improve patients with systemic venous congestion and haemodynamic instability. This study aimed to describe the changes in systemic venous congestion and peripheral perfusion parameters induced by a fluid challenge in these patients, and to analyse the influence of the fluid responsiveness status on these changes.MethodsThe study is a single-centre prospective cohort study of 36 critically ill ICU patients with haemodynamic instability and a maximum vena cava diameter ≥ 20 mm. Changes in cardiac index during a fluid challenge (4 mL/kg of lactated Ringer’s solution during 5 min) assessed by pulse contour analysis, central venous pressure, ultrasound systemic congestion parameters (portal venous flow pulsatility index, supra hepatic and intrarenal venous Doppler), and peripheral perfusion parameters (capillary refill time and peripheral perfusion index) were assessed in the overall population. All these data were compared between patients presenting a cardiac index increase > 10% during the fluid challenge (fluid responders) and the others (fluid non-responders).ResultsTwenty-eight (78%) patients were admitted for postoperative care following cardiac surgery; their mean ± SD left ventricular ejection fraction was 42 ± 9% and right ventricular dysfunction was found in at least 61% of the patients. The mean ± SD SOFA score was 9 ± 3. Thirteen (36%) patients were fluid responders. The fluid challenge administration induced a significant increase in portal pulsatility index, VExUS score, and central venous pressure without significant difference of these changes between fluid responders and non-responders. No significant change in perfusion parameters was observed.ConclusionFluid administration in patients with haemodynamic instability and systemic venous congestion worsens venous congestion regardless of the fluid responsiveness status, without improving perfusion parameters.

Atypical Milroy's disease with predominant unilateral involvement: a case report

Milroy's disease (MD), known as hereditary lymphedema type I, is a rare autosomal dominant primary lymphedema. It accounts for about twenty percent of all primary lymphedema. MD typically presents clinically with bilateral lower extremity lymphedema. Our case report describes a rare case of MD presenting with unilateral upper and lower extremity lymphedema in a patient admitted to our clinic. A 24-year-old woman who had been followed for lymphedema since the age of 8 was diagnosed with MD at our hospital by physical examination, venous Doppler ultrasound, whole-body lymphoscintigraphy, and molecular genetic testing. Partial improvement was observed with complete decongestive therapy, considered the gold standard treatment for lymphedema. Genetic counseling may be beneficial for the patient and family. Although MD is uncommon in the literature, many more studies are needed to identify carrier variants in the community.

Evaluation of Lower Extremity Venous Doppler Ultrasonography Outcomes Before And After The COVID-19 Pandemic; A Retrospective Study

Objectives: COVID-19 PCR positivity has been reported among asymptomatic individuals and asymptomatic people are also considered to be at risk for thromboembolic events. The aim of this study was to compare the results of patients who underwent lower extremity Doppler ultrasonography (DUS) with a preliminary diagnosis of deep vein thrombosis (DVT) before and after the pandemic, regardless of COVID-19 PCR testing. Methods: Patients who underwent RDUS in the Department of Radiology during a total period of 35 months (01/08/2018 - 01/07/2021) were analyzed. A total of 599 patients underwent RDUS during the study period. Results: More pozitif DVT findings were observed after the pandemic (n=43, 18.3%, p=0.005) (only two of these patients had a positive COVID-19 PCR result). History of hospitalization in the last three months, D-dimer, PLT, MPV, WBC, neutrophil count, lymphocyte count, NLR values, comorbidity and antiaggregant use were not different (p>0.05). Conclusion: Even individuals (especially elderly individuals) who have been exposed to the virus during the pandemic but who do not show symptoms are at risk of DVT.

Benefits of prophylactic carotid revascularization in patients with asymptomatic carotid artery stenosis undergoing coronary artery bypass surgery: A narrative review.

Patients undergoing coronary artery bypass grafting (CABG) are at increased risk of perioperative stroke. Carotid atherosclerosis has been identified as an independent risk factor for stroke during and in the early postoperative period of cardiac surgery. However, the pathogenesis of peri-CABG stroke is multifactorial and frequently involves other noncarotid causes, such as cardiac emboli and aortic atheroma. Therefore, routine population-wide screening of carotid stenosis is not recommended, but target screening of patients at high risk of carotid-related perioperative stroke can have benefits. Carotid duplex sonography is recommended as an initial screening tool. Elimination of carotid stenosis before cardiac surgery is indicated in patients in whom carotid atherosclerosis is suspected to be the primary contributor to perioperative stroke. In patients with advanced carotid atherosclerosis, an individualized revascularization approach, including simultaneous or staged procedures, is advocated. The prevailing consensus is that synchronous surgery is safer than staged procedures. Carotid artery stenting represents a less invasive alternative, but its role in high-risk patients requires further investigation. In conclusion, the risk of perioperative stroke in patients undergoing CABG involves different factors, and carotid artery stenosis is involved in its pathogenesis only in some patients. Therefore, individualized approaches and careful consideration of patient risk factors are essential in determining the need for carotid screening and revascularization before CABG.

Optimizing venous anastomosis for forearm loop arteriovenous grafts: A comparative analysis of elbow veins and upper arm basilic veins in end-stage kidney disease patients.

Optimizing vascular access for hemodialysis in end-stage kidney disease is crucial. While arteriovenous fistulas (AVFs) are preferred for better patency and fewer complications, many patients require alternatives options like arteriovenous grafts (AVGs) due to anatomical constraints. This study compares outcomes between elbow and upper arm (UA) basilic veins for forearm loop AVGs, highlighting the potential benefits of the UA basilic vein to improve patency and feasibility in patients with poor elbow veins through retrospective analysis. This retrospective study analyzed 59 limbs of patients who underwent forearm loop AVG formation from January 2018 to June 2022. Elbow veins (basilic, median cubital, brachial) and UA basilic veins were evaluated for suitability using duplex ultrasonography. AVG decisions were based on patient age, health, and vein diameter (⩾2.3 mm). Statistical analyses compared baseline characteristics and evaluated primary and secondary patency rates at 12 and 18 months using Pearson's chi-square, Student's t-test, Kaplan-Meier survival analysis, and the Log-rank test. Thirty-six patients had elbow anastomosis, while 23 had UA anastomosis for forearm loop AVG. The elbow group had a higher male proportion (72.7% vs 34.7% in UA, p = 0.005) and larger elbow vein diameters (2.52 ± 0.19 mm vs 2.16 ± 0.21 mm in UA, p < 0.001). Primary patency rates at 12 months were 72.7% for elbow and 56.2% for UA; at 18 months, 59.4% and 25.5%, respectively (p = 0.376). Secondary patency rates at 12 months were 75.7% for elbow and 62.2% for UA; at 18 months, 67.8% and 33.9%, respectively (p = 0.238). The primary and secondary patency rates of forearm loop AVG with UA basilic vein anastomosis were not inferior to those with elbow veins anastomosis. UA basilic vein can be a feasible alternative for creating forearm loop AVG when elbow veins are not suitable.

Iliac vein obstruction: accuracy of Direct Multidetector Computed Tomographic Venography and duplex ultrasound.

To evaluate the accuracy of direct computed tomographic venography (DCTV) and duplex ultrasound (DUS) in the identification of iliac vein obstruction in highly symptomatic patients with severe chronic venous disease (CVD) compared with intravascular ultrasound (IVUS). this study involved patients who had advanced CVD (CEAP C3-6). All patients underwent DCTV, venous duplex scanning, and IVUS. The presence of iliac vein obstruction was detected, and degree of obstruction was classified into 3 grades (grade I, 0% to 49%; grade II, 50% to 79%; and grade III, 80% or greater). The sensitivity, specificity, PPV, NPV, and accuracy were calculated for each modality compared with IVUS. Inter-observer agreement was assessed using the κ coefficient. of 94 patients with CVD, IVUS identified iliac vein obstruction in 55 (58.5%) patients (25.5% was grade 1, 27.3% was grade 2, 47.3% was grade 3). The sensitivity, specificity of DCTV in diagnosing obstruction was (96%, 95% in grade 1; 100%, 100% grade 2; 100%, 100% in grade 3, respectively). The sensitivity, specificity of DUS was (63.9%, 65% in grade 1; 68%, 82% in grade 2, and 70%, 85% in grade 3, respectively). The overall agreement of DUS was 0.73 (95% CI, 0.70-0.79), and DCTV was 0.96 (95% CI, 0.91- 0.97). DUS is a reasonable initial imaging modality for the identification of significant iliac vein obstruction. DCTV provides an accurate reproducible imaging for accurate estimation needed for treatment planning. Direct CT Venography provides accurate reproducible radiological information required for treatment planning of patients with Iliac vein obstruction including accurate assessment of site of obstruction, its morphology, and degree of obstruction and it can replace the use of indirect CT venography using smaller amount of contrast media with accurate diagnosis.

Bedside 3D ultrasound fistula maturation assessment by non-expert sonographers provides equivalent accuracy to formal duplex sonography: A prospective clinical trial.

EchoSure is an automated point-of-care 3D ultrasound (3DUS) designed to be used by dialysis technicians without advanced ultrasound training. The EchoMark/EchoSure System is a two-part system comprised of a bioresorbable implant, EchoMark, and a diagnostic ultrasound imaging platform, EchoSure. EchoSure was designed to enable any healthcare personnel in a dialysis clinic setting to obtain non-invasive, direct measurements of flow and vessel parameters that are critical quantifications used in the assessment of AVF maturation and readiness for hemodialysis cannulation. In this pilot feasibility study, we sought to explore whether use of an automated 3DUS could enable fistula assessment by non-experts and obtain measurement accuracy comparable to expert sonographer Duplex. This was a 20 subject prospective multicenter trial conducted at four sites in the United States. All subjects had an EchoMark implanted under their AVF during the fistula creation procedure. Subjects were evaluated at 2-weeks post-op with EchoSure and Duplex, followed by monthly assessments until either the 4-month visit or until radiographic maturation was achieved, whichever was longer. Beyond monthly ultrasound assessments, clinical follow-up continued every 6 months between months 6 and 24. Technical success of EchoMark implantation was demonstrated in 100% of subjects. Technical success of EchoSure was 99% across all scans. The mean percent difference in flow rate measurements between EchoSure and Duplex was -9.2% with a standard deviation of 38.1% compared to a mean percent difference of -15.7% with a standard deviation of 35.5% between Duplex measurements taken at the cannulation zone and brachial artery. Pearson correlation between EchoSure and Duplex was 0.708 versus 0.716 for the two Duplex measurements. Radiographic maturation was achieved in 70% of study subjects by 30 days and continued to rise to 90% through 90 days and 95% through 180 days after baseline. This study demonstrates the feasibility and accuracy of an automated 3D ultrasound system for assessment of maturation at the dialysis bedside by non sonographers.

Duplex ultrasonography for screening and monitoring of carotid artery stenosis for risk stratification of ischemic stroke

Aim: To evaluate the efficiency of Duplex Ultrasonography (DUS) for monitoring and screening of Carotid Artery Stenosis (CAS).Methods: PubMed, Web of Science, Cochrane, and SCOPUS were searched for relevant articles. The quality assessment of the included studies was conducted according to the Cochrane Risk of Bias Tool.Results: Our meta-analysis included six articles. We found that carotid DUS could detect mild CAS in 25%, moderate CAS in 13%, severe CAS in 14.5% of the examined vessels, detection of carotid artery plaques in 36.5% of the examined vessels, and abnormal intima thickness in 21.5% of the examined vessels.Conclusion: DUS is an important exam in the identification of patients with symptomatic CAS. It can improve clinical practice and provide cost-effective management for CAS. Carotid DUS showed high specificity and sensitivity in the diagnosis of CAS, especially a severe degree of stenosis

Predictive value of renal shear wave elastography in liver cirrhosis

BackgroundIn liver cirrhosis, prognosis is profoundly affected by renal function. This study evaluates the usefulness of renal stiffness measurement by point-shear wave elastography and renal perfusion by duplex. MethodsIn this case-control study, organ stiffness was quantified using point-shear wave elastography and duplex sonography to calculate the arterial resistive (RI) and pulsatility indices (PI) in 123 patients, including patients with liver cirrhosis with (LC+A) and without ascites (LC-A) and patients without liver cirrhosis (NLC). ResultsPI and RI were significantly increased in LC-A and LC+A compared to NLC (p<0.001) and correlated with MELD and Child Pugh scores. Point-shear wave elastography showed significantly lower renal stiffness in LC+A compared to LC-A (p<0.01) and NLC (p<0.001). Renal stiffness correlated inversely with MELD and Child Pugh scores.Reduced renal stiffness, but not PI or RI, was associated with the presence of hepatorenal syndrome (p<0.001). Reduced renal stiffness was associated with an increased risk of death due to complications of liver cirrhosis within 3 years (p<0.01). ConclusionPoint-shear wave elastography and duplex sonography correlate with progression of liver cirrhosis, but only shear wave elastography represents a valuable prognostic tool for hepatorenal syndrome and mortality in patients with liver cirrhosis.

Central Venous Catheter-associated Venous Thromboembolism in Children: A Prospective Observational Study.

Our objective was to study the proportion of children developing Catheter-related thrombosis (CRT) following central venous Catheter (CVC) insertion and the risk factors of CRT in pediatric patients with CVC. One hundred four children aged 29 days to 18 years who had a percutaneous non-tunneled CVC inserted were enrolled. Ultrasonogram (USG) with venous Doppler scan was performed within 48 hours of CVC removal to diagnose CRT. The major indications for CVC insertion were surgical care 34 (32.6%) and ICU care 28(26.9%). The median age of the patients was 3 years, and 75% were males. The median number of CVC days was 10 (IQR 5.15). CRT was seen in 45(43.3%), of which 33 (73.3%) were asymptomatic. The rate of CRT was 35.69 cases per 1000 CVC days (95% CI 26.03-47.75). The number of days a catheter was in place and USG-guided catheter insertion was a significant risk factor. The multivariate logistic regression model showed that the duration of CVC in situ was independently associated with the development of CRT (OR, 1.06; 95% CI 1.0-1.1; P =0.02). CVC duration was a major risk factor for the development of CRT. There was a higher risk of developing a symptomatic CRT with central venous catheters than hemodialysis sheaths.

Comparing Carotid Artery Velocities with Current ASCVD Risk Stratification: A Novel Approach to Simpler Risk Assessment.

To explore the potential of a novel approach to simplify risk assessment by comparing carotid artery velocities with current atherosclerotic cardiovascular disease (ASCVD) risk stratification method using nonlinear measurements. In this prospective study conducted at a medical center in southern Taiwan from January 1, 2020, to December 31, 2021, 1636 participants aged 40-75 years without prior ASCVD events were enrolled. Carotid flow velocity was obtained through duplex ultrasonography. ASCVD risk was categorized into two groups according to the 2022 USPSTF guidelines for primary prevention. We analyzed associations between flow indices and ASCVD risk using logistic regression and generalized additive models (GAMs). The end diastolic velocity (EDV) of common carotid artery (CCA) and the peak systolic velocity (PSV) of internal carotid artery (ICA) were inversely and nonlinearly associated with cardiovascular event risk. Multivariate logistic regression analysis with ROC curves revealed that the optimal speed for the EDV of CCA was approximately 23.75cm/s, and the optimal PSV and EDV of ICA were approximately 81.75cm/s and 26.75cm/s, respectively. The GAMs showed U-shaped relationships between elevated ASCVD risk and blood flow velocity in the carotid arteries, with inflection points of approximately 82cm/s in the PSV of ICA and near 25cm/s in the EDV of CCA. Both methods revealed similar results. The EDVs and PSVs of the CCA and ICA are associated with the development of cardiovascular events. Optimal velocity ranges were identified; however, further hemodynamic investigations are warranted.

Diagnostic Potential of Combined Photoplethysmography and Ankle-Brachial Index in Peripheral Arterial Disease: A Duplex Ultrasonography-Based Comparative Study.

Although ankle-brachial index (ABI) and photoplethysmography (PPG) have also shown adequate sensitivity in detecting peripheral arterial disease, their diagnostic performance is less reliable in asymptomatic cases or those with high atherosclerotic cardiovascular risks. We evaluated 130 participants using ABI, PPG, and duplex ultrasonography, diagnosing 65 with peripheral arterial disease. From the PPG, we derived 2 parameters: PPG amplitude ratio of the lower-to-upper extremities (PPGratio) and the PPG amplitude of the lower extremity (PPGamp). Sensitivity, specificity, accuracy, and the area under receiver operating characteristic (ROC) curve were calculated for PPG parameters and ABI, and their combination of both methods. Univariate and multivariate logistic regression assessed the prognostic potential of these parameters. ROC analysis revealed optimal cutoff values in diagnosing peripheral arterial disease were 0.417 for PPGratio and "58" for PPGamp. Both PPGratio and PPGamp demonstrated significantly higher sensitivities, 78.4% and 75.7%, respectively, compared with 55.9% for ABI <0.9 (P<0.05). The areas under the ROC curves of combination models, including model 1 (ABI <0.9 and PPGratio), model 2 (ABI <0.9 and PPGamp), and model 3 (ABI <0.9, PPGratio, and PPGamp), exhibited improved performance with areas under the ROC curves of 0.922, 0.922, and 0.931 (all P<0.01) compared with ABI alone (area under the ROC curve, 0.822). Additionally, the PPG parameters, both alone and combined with ABI, were associated with major adverse cardiac events and all-cause mortality after adjusting for other relevant factors. On the basis of duplex ultrasonography, combining ABI and PPG markedly improves peripheral arterial disease diagnosis in high-risk individuals compared with either method alone and provides crucial insights into major adverse cardiac events and all-cause mortality risks.

Subclinical carotid atherosclerosis in gouty patients: relation to musculoskeletal ultrasonographic findings and serum sclerostin level

Objectives. To detect subclinical carotid atherosclerosis in gout patients and its relation to musculoskeletal ultrasound (MSK US) manifestations and serum sclerostin (SCL) levels. Patients and methods. Thirty Egyptian gouty patients were classified into two groups: Group A included 15 patients with diagnostic MSK US manifestations of gout (double contour sign), and Group B included 15 patients without MSK US findings. MSK US was done for both knees and the first MTP joints. Carotid duplex ultrasonography was done to evaluate carotid intima-media-thickness (CIMT) and serum SCL level was measured in all patients by ELISA technique. Results. Gouty patients with MSK US findings had a significantly higher increase in serum SCL levels than those without MSK US findings (p &lt;0.01). Group A patients had a significantly greater CIMT than patients of group B (p &lt;0.01). Serum uric acid and SCL levels were found to be significantly positively correlated. The ROC curve revealed that the optimal SCL cutoff value for detecting positive MSK US findings in gout patients was &gt;25.05 ng/ml. At this level, there was a significant difference between the patients with a CIMT &gt;0.9 mm and the patients with a CIMT ≤0.9 mm (p &lt;0.05). Conclusions. Patients with MSK US manifestations of gout are more liable to have subclinical carotid atherosclerosis than patients without these manifestations. SCL at a certain level &gt;25.05 ng/ml in gout patients might predispose patients to radiographic findings of MSK US of gout and subclinical atherosclerosis.

Arterial and Venous Doppler in Evaluation of the "At-risk" Fetus.

Our practice utilizes Doppler ultrasound as one of the most objective and effective methods to assess at-risk pregnancies. This review will discuss the application of arterial and venous Doppler techniques in assessing and managing various diseases and conditions for high-risk fetuses.

Cerebrovascular pulsatility indicates preoperative subcortical cognitive impairment and an increased risk for postoperative delirium in elderly patients undergoing elective spine surgery.

Advances in spine surgery enable safe interventions in elderly patients, but perioperative neurocognitive disorders (pNCD), such as post-operative delirium (POD) and cognitive dysfunction (POCD), remain a serious concern. Pre-operative cognitive impairment is a major risk factor for pNCD. Comprehensive pre-operative cognitive assessments are not feasible in clinical practice, making effective screening methods desirable. This study investigates whether pre-operative cerebrovascular duplex sonography can assess subcortical (vascular) cognitive impairment and the risk for POD. This prospective single-center study recruited patients aged ≥60 years scheduled for elective spine surgery at a German university hospital. Patients underwent pre-operative assessments including cognitive abilities (CERAD test battery), structural MRI, and cerebrovascular duplex sonography. POD screening was conducted three times daily for at least 3 days. The primary hypothesis, that the mean pulsatility index (PI) of both internal carotid arteries (ICA) predicts POD risk, was tested using logistic regression. Secondary analyses examined the association between POD risk and ICA flow (time-averaged peak velocities, TAPV) and correlations with cognitive profiles and MRI characteristics. POD occurred in 22% of patients (n = 22/99) within three postoperative days. Patients with POD were significantly older (75.9 ± 5.4 vs. 70.0 ± 6.9 years, p < 0.01) but did not differ by gender (p = 0.51). ICA PI significantly predicted POD risk (OR = 5.46 [95%CI: 1.81-16.49], p = 0.003), which remained significant after adjustment for age and duration of surgery (ORadj = 6.38 [95% CI: 1.77-23.03], p = 0.005). TAPV did not inform the POD risk (p = 0.68). ICA PI Pre-operative cognitive scores were significantly associated with ICA PI (mean CERAD score: r = -0.32, p < 0.001). ICA PI was also significantly associated with total white matter lesion volume (τ = 0.19, p = 0.012) and periventricular white matter lesion volume (τ = 0.21, p = 0.007). This is the first study to demonstrate that cerebrovascular duplex sonography can assess the risk for POD in elderly spine surgery patients. Increased ICA PI may indicate subcortical impairment, larger white matter lesion load, and lower white matter volume, predisposing factors for POD. Pre-operative cerebrovascular duplex sonography of the ICA is widely available, easy-to-use, and efficient, offering a promising screening method for POD risk. Increased ICA PI could supplement established predictors like age to adjust surgical and peri-operative procedures to individual risk profiles.

Anatomical variations of origin of the internal carotid artery: Report of two cases and systematic review of the literature.

Anatomical variations of origin of the internal carotid artery (ICA) are very uncommon and may pose a diagnostic and therapeutic challenge. We report a case of direct origin of the right ICA from the innominate artery (aplasia of common carotid artery) and a case of duplication of right ICA in healthy patients who performed duplex ultrasound (DUS) for primary cardiovascular prevention screening. In both cases, the ultrasound scan was performed both in a transverse plane and on the longitudinal axis, and in one of the two cases, a computed tomography angiography was performed to confirm the diagnosis. A review of the current literature about anatomical variations of origin of carotid arteries was also performed. The most frequent congenital anomaly is represented by the aplasia of the CCA, followed by the agenesis and by the duplication of the ICA. In most cases, the anomaly is discovered occasionally and symptoms are aspecific. Diagnosis is usually confirmed through a multimodality imaging approach, including DUS of extracranial carotid arteries, magnetic resonance imaging (MRI), and computed tomographic angiography. In most cases, treatment was conservative, with pharmacological therapy aimed at the symptoms. The recognition of such variations is mandatory, particularly when the patient needs a surgical treatment that may involve the vessel with the anatomical variations.

Innovative Approaches and Future Directions in the Management and Understanding of Varicose Veins: A Systematic Review.

Varicose veins, a prevalent condition that primarily affects the lower limbs, present significant hurdles in diagnosis and treatment due to their diverse causes. This study dives into the complex hormonal, environmental, and molecular elements that influence varicose vein genesis, emphasizing the need for precise diagnostic methods and changing therapy approaches to improve patient outcomes. It investigates the epidemiology and demographic distribution of varicose veins, delves into their pathophysiology, and assesses diagnostic methods such as duplex ultrasonography and the CEAP classification system. In addition, the study discusses novel therapies such as sclerotherapy and endovenous thermal ablation, as well as the effectiveness of existing diagnostic methods in detecting chronic venous illnesses. By investigating venous wall remodeling and inflammatory pathways, it gives a thorough knowledge of varicose vein formation. The study calls for future research that focuses on patient-centered methods, bioengineering advances, digital health applications, and genetic and molecular studies to improve the accuracy and effectiveness of vascular therapy. As a result, a multidisciplinary literature analysis was done, drawing on insights from vascular medicine, epidemiology, genetics, and pharmacology, to consolidate existing knowledge and identify possibilities to enhance varicose vein diagnosis, treatment, and patient care outcomes.