Duplex Ultrasonography Findings Research Articles

Comparison of Duplex Ultrasound and Digital Subtraction Angiography for Assessing Tibial Vessel Disease.

Background Duplex ultrasonography (DUS) is readily available and often used as the first diagnostic test for patients with peripheral artery diseases (PADs). PAD is a disease that affects the general population but more commonly affects diabetics.To date, the role of DUS in the assessment of tibial vessel disease is inconclusive at best. The goal of our study is to assess the validity of DUS in characterizing the presence and severity of tibial diseasesvia comparison with digital subtraction angiography (DSA) findings. Methods This is a single-center retrospective cohort study analyzing three arterial segments (anterior tibial, posterior tibial, and fibular arteries) in patients who received a duplex study followed by DSA within a 30-day period. All arterial segments were graded from normal (Grade 0) to occluded (Grade 4), based on duplex interpretationand directly compared to direct visualization findings from DSA. Using statistical methods, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DUS were determined. Results A total of 171 tibial vessel segments from 57 enrolled subjects with critical limb ischemia symptoms were analyzed in this study. The agreement between both modalities was poor (Kappa=0.19, p < 0.05), with DUS demonstrating a significant underestimation of vessel pathologies. This is also reflected by the overall sub-optimal sensitivity (23%), specificity (84%), PPV (69%), and NPV (41%) in DUS when compared to DSA results as the gold standard. Conclusion Significant disagreements were noted in this study between DUS and DSA findings, primarilysignificant underestimation of tibial vessel disease by the DUS when compared with the DSA. Caution is advised in the clinical application of DUS in patients with chronic limb-threatening ischemia (CLTI) symptoms and multi-segment tibial vessels due to its demonstrated limitations in this study.

Association of duplex ultrasonography findings with the severity of chronic venous disease in Thai patients

Chronic venous disease (CVD) is characterized by venous hypertension and stasis, which occur because of valvular incompetence and/or venous outflow obstruction. This study aimed to investigate the relationship between CVD clinical presentation and duplex ultrasonography findings in a Thai patient population. This cross-sectional study examined patients diagnosed with CVD at the Chulabhorn Hospital Vascular Clinic (Bangkok, Thailand) between December 1, 2018 and October 1, 2021. Patient data was obtained from the medical records and review of lower limb venous ultrasonography studies. Patients were assessed using the Clinical, Etiological, Anatomical, and Pathological (CEAP) classification of venous disorders: mild-to-moderate CVD was defined as C1 to C3 and severe CVD was defined as C4 to C6. Overall, 260 CVD patients were analyzed (60 men and 200 women). More than 75% of the patients were women and more than 80% had bilateral lower limb involvement. Factors associated with severe CVD were older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (38.8%), followed by C1 (33.85%), C4 (12.2%), C3 (9.23%), C6 (3.46%), and C5 (2.31%). Two-thirds of the patients had great saphenous vein reflux and nearly half had perforator vein reflux. Perforator reflux and small saphenous vein reflux were significantly associated with severe CVD (P<0.001 and P=0.028, respectively). Higher number of venous systems involved was significantly associated with severe CVD (P=0.005). Reflux time of the great saphenous vein correlated with severe CVD and VCSS (P=0.026 and P=0.037, respectively). Mean diameters of the superficial vein, perforator vein, and deep vein and reflux times of the perforator and deep veins were not significantly associated with severe CVD. The major risk factors for severe CVD are older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (39%). Great saphenous vein reflux was the most common type of reflux in our study population. Increasing number of venous systems involved increased the risk of severe CVD. The presence of perforator vein reflux and small saphenous vein reflux also increased the risk of severe CVD. Reflux time of the great saphenous vein correlated with severe CVD and venous clinical severity score.

Myths and truths about varicose veins

Background: Varicose veins are a common chronic venous disorder that leads to a significantly reduced quality of life and high healthcare resource burden. There is a large amount of research-based data and opinions regarding varicose veins. There are also some common myths and misconceptions about the treatment options.Current Concepts: Management options include compression therapy, open venous surgery, and endovenous therapy. An appropriate treatment option must be selected on a case-by-case basis based on the symptoms, severity, and duplex ultrasonography findings. Venous intervention should be considered if the condition is symptomatic and often, there is no need for urgent surgery or endovenous therapy because the symptoms usually progress slowly and severe cardiac problems are rare. According to previous studies, there is no difference between the endovenous therapy modalities and the traditional surgical method (i.e., high ligation and stripping) in terms of recurrence rates. Therefore, case-specific factors, such as anatomy and economic factors, should be considered. When compression therapy is considered, graduated compression stocking with suitable pressure should be prescribed. Venoactive drugs can be suggested in addition to compression therapy for symptomatic varicose veins or venous ulcers.Discussion and Conclusion:. Correct information regarding treatment for varicose veins based on the best available evidence must be provided to patients. The treatment options for varicose veins should be selected on a case-by-case basis considering the patient`s symptoms, anatomy and economic factors.

Color duplex ultrasonography findings of temporal arteries in a case of giant cell arteritis: role in diagnosis and follow-up

Giant cell arteritis (GCA) is a systemic autoimmune disease that affects medium- and large-sized arteries. The diagnostic gold standard is the temporal artery biopsy, but it has limited sensitivity and some difficulties in reproducibility. Color duplex ultrasonography is a noninvasive, reproducible, and inexpensive method for diagnosis of temporal arteries involvement (temporal arteritis [TA]) in GCA with high sensitivity and specificity. We present the ultrasound findings at baseline and during follow-up in a case of TA in a patient with GCA.

Duplex ultrasonography findings are not related to menstrual cycle phases in women with early symptoms of lower extremity chronic venous disease.

To investigate if duplex ultrasonography findings change according to the menstrual cycle phases in women with early symptoms of lower extremity chronic venous disease. Thirty women (60 extremities) aged 18-50 years with regular menstrual cycles who presented with complaints of telangiectasia and/or trunk varices with accompanying leg pain were evaluated prospectively by duplex ultrasonography at three different times of a single menstrual cycle. Previous DVT or menstrual irregularities were exclusion criteria. All exams were performed by the same radiologist, under the same conditions. Reflux was provoked in the deep veins, great saphenous vein (GSV), and small saphenous vein (SSV) using the Valsalva maneuver. Reflux times in each vein and average diameters of the GSV and SSV were recorded. Reflux times showed no significant differences in any of the vein segments and the diameters of GSV and SSV were similar in the different menstrual phases (p > 0.05). Reflux was not predominant at any specific phase, and its presence was independent of menstrual phase. Reflux was not specific to a particular phase of menstrual cycle in women with early symptoms of chronic venous disease.

Effect of Chronic Venous Insufficiency on Activities of Daily Living and Quality of Life: Correlation of Demographic Factors With Duplex Ultrasonography Findings

The study evaluates to what extent symptoms of chronic venous insufficiency (CVI) and functional venous incompetence as investigated using color-coded duplex ultrasonography may interfere with activities of daily living (ADLs). This study comprises a cross-sectional survey conducted in urban areas surrounding 24 Italian cities. A spontaneous sample of 5,187 subjects (4,457 women [mean age, 54 years] and 730 men [mean age, 61 years]), selected by advertising on television and in newspapers, underwent a clinical examination that included duplex ultrasonography in 3 vein segments in both legs to determine the presence and severity of venous reflux. Subjective perception of lower limb symptoms of CVI and the effect of leg problems on the ability to perform normal ADLs are assessed by means of a self-administered questionnaire. Most of the respondents have some CVI symptoms, with women being 1.5 to 3 times as likely as men to report leg symptoms. The risk of developing the most frequent subjective symptoms such as heaviness and tiredness in the legs is not statistically significantly different for younger subjects compared with older subjects. Advanced age is considered to be a relevant risk factor only for heat sensation and swollen legs. Persons living in southern Italy are at higher risk of almost all lower limb symptoms. Results of duplex ultrasonography performed on 3875 subjects show that fewer than 1 in 5 young persons, regardless of sex, manifest some degree of venous reflux (primarily mild symptoms). The risk of developing venous incompetence increases rapidly with age until it triples among subjects 50 years and older. Adjusting for all other factors, men are on average 1.5 times as likely as childless women to have venous reflux, and the risk increases in the case of family history of CVI or (among women) in the case of past pregnancies. More women than men report that their leg problems affect their ADLs. Pregnancy and living in the south contribute to a reduction in the ability to perform most heavy housework. Although milder lower limb symptoms such as evening heaviness and tiredness in the legs may begin early in life, venous reflux and related symptoms of heat sensation and swollen legs become more pronounced with age, and their severity can be disabling for those afflicted.

Endovenous Laser Ablation (EVLA) of Great Saphenous Vein to Abolish “Paradoxical Reflux” in the Giacomini Vein: A Short Report

Reflux in the GSV due to sapheno-popliteal incompetence associated with ascending (paradoxical) reflux in the Giacomini vein is a rare but well described pattern of reflux. Treatment of this type of reflux is controversial and only surgical treatment has been described. We describe 2 patients in whom this type of reflux was successfully abolished following endovenous laser ablation (EVLA) of the GSV with the SPJ and Giacomini vein regaining competency. Paradoxical reflux in the Giacomini vein and SPJ is secondary to GSV incompetence which exerts a syphon effect. EVLA of the refluxing segment of GSV interrupts this effect and prevents the paradoxical reflux at the SPJ.

Transcranial Doppler and Carotid Duplex Ultrasonography Findings in Bow Hunter's Syndrome

Bow hunter's syndrome (BHS) is caused by transient vertebro-basilar ischemia on head rotation. We report a patient with BHS who was identified from dynamic changes to blood flow velocities in the posterior cerebral, basilar and vertebral arteries using carotid duplex ultrasonography and transcranial Doppler, simultaneously. Neurosonology appears to be useful for diagnosing and evaluating BHS.

Clinical and Ultrasonographic Manifestations in Major Causes of Common Carotid Artery Occlusion

Atherosclerosis is the main cause of common carotid artery occlusion in most reports. This study aimed to identify the major causes of common carotid artery occlusion and compare the clinical features and carotid duplex ultrasonography findings of patients with common carotid artery occlusion attributable to each cause. Patients with common carotid artery occlusion documented by carotid duplex ultrasonography at the Neurovascular Laboratory (National Taiwan University Hospital) from 1988 to 2003 were included. Medical records and ultrasonographic findings were reviewed in detail to clarify the possible etiology of common carotid artery occlusion. A total of 44 patients (male, 27 [61%]; female, 17 [39%]; mean age, 58 years) had common carotid artery occlusion attributable to a carotid duplex ultrasonography-identifiable cause. The causes of common carotid artery occlusion included atherosclerosis (17 [39%]), Takayasu's arteritis (11 [25%]), postirradiation arteriopathy (7 [16%]), cardiac embolism (6 [14%]), syphilis (1), blunt trauma (1), and homocystinuria (1). Among the patients with common carotid artery occlusion due to the 4 major causes, 27 (66%) had ischemic stroke and 14 (34%) had no symptoms or nonlocalizing symptoms. The frequency of symptomatic com mon carotid artery occlusion was 83% in those with cardioembolism, 76% in those with atherosclerosis, 71% in those with postirradiation arteriopathy, and 36% in those with Takayasu's arteritis. Common carotid artery occlusion usually involved the carotid bulb and distal common carotid artery in atherosclerosis (88%) and postirradiation arteriopathy (100%), but not in Takayasu's arteritis (27%). Echogenicity of occluded material was heterogeneous in atherosclerosis and post-irradiation arteriopathy patients but homogeneous in all Takayasu's arteritis patients. The authors postulate that the thrombotic mechanism might differ according to etiology. The causes of common carotid artery occlusion are diverse. Atherosclerosis, Takayasu's arteritis, and post-irradiation arteriopathy are the most common causes of com mon carotid artery occlusion in Taiwan. The clinical features, pathophysiology, and carotid duplex ultrasonography findings vary according to the cause of common carotid artery occlusion.

Clinical and Ultrasonographic Manifestations in Major Causes of Common Carotid Artery Occlusion

Atherosclerosis is the main cause of common carotid artery occlusion in most reports. This study aimed to identify the major causes of common carotid artery occlusion and compare the clinical features and carotid duplex ultrasonography findings of patients with common carotid artery occlusion attributable to each cause.Patients with common carotid artery occlusion documented by carotid duplex ultrasonography at the Neurovascular Laboratory (National Taiwan University Hospital) from 1988 to 2003 were included. Medical records and ultrasonographic findings were reviewed in detail to clarify the possible etiology of common carotid artery occlusion.A total of 44 patients (male, 27 [61%]; female, 17 [39%]; mean age, 58 years) had common carotid artery occlusion attributable to a carotid duplex ultrasonography-identifiable cause. The causes of common carotid artery occlusion included atherosclerosis (17 [39%]), Takayasu's arteritis (11 [25%]), postirradiation arteriopathy (7 [16%]), cardiac embolism (6 [14%]), syphilis (1), blunt trauma (1), and homocystinuria (1). Among the patients with common carotid artery occlusion due to the 4 major causes, 27 (66%) had ischemic stroke and 14 (34%) had no symptoms or nonlocalizing symptoms. The frequency of symptomatic com mon carotid artery occlusion was 83% in those with cardioembolism, 76% in those with atherosclerosis, 71% in those with postirradiation arteriopathy, and 36% in those with Takayasu's arteritis. Common carotid artery occlusion usually involved the carotid bulb and distal common carotid artery in atherosclerosis (88%) and postirradiation arteriopathy (100%), but not in Takayasu's arteritis (27%). Echogenicity of occluded material was heterogeneous in atherosclerosis and post-irradiation arteriopathy patients but homogeneous in all Takayasu's arteritis patients. The authors postulate that the thrombotic mechanism might differ according to etiology.The causes of common carotid artery occlusion are diverse. Atherosclerosis, Takayasu's arteritis, and post-irradiation arteriopathy are the most common causes of com mon carotid artery occlusion in Taiwan. The clinical features, pathophysiology, and carotid duplex ultrasonography findings vary according to the cause of common carotid artery occlusion.

Magnetic Resonance Angiography in the Follow-up of Distal Lower-Extremity Bypass Surgery: Comparison with Duplex Ultrasound and Digital Subtraction Angiography

The danger of limb loss as a consequence of acute occlusion of infrapopliteal bypasses underscores the requirement for careful patient follow-up. The objective of this study was to determine the agreement and accuracy of contrast material-enhanced moving-table magnetic resonance (MR) angiography and duplex ultrasonography (US) in the assessment of failing bypass grafts. In cases of discrepancy, digital subtraction angiography (DSA) served as the reference standard. MR angiography was performed in 24 consecutive patients with 26 femorotibial or femoropedal bypass grafts. Each revascularized limb was divided into five segments--(i) native arteries proximal to the graft; (ii) proximal anastomosis; (iii) graft course; (iv) distal anastomosis; and (v) native arteries distal to the graft-resulting in 130 vascular segments. Three readers evaluated all MR angiograms for image quality and the presence of failing grafts. The degree of stenosis was compared to the findings of duplex US, and in case of discrepancy, to DSA findings. Two separate analyses were performed with use of DSA only and a combined diagnostic endpoint as the reference standard. Image quality was rated excellent or intermediate in 119 of 130 vascular segments (92%). Venous overlay was encountered in 26 of 130 segments (20%). In only two segments was evaluation of the outflow region not feasible. One hundred seventeen of 130 vascular segments were available for quantitative analysis. In 109 of 117 segments (93%), MR angiography and duplex US showed concordant findings. In the eight discordant segments in seven patients, duplex US overlooked four high-grade stenoses that were correctly identified by MR angiography and confirmed by DSA. Percutaneous transluminal angioplasty was performed in these cases. In no case did MR angiography miss an area of stenosis of sufficient severity to require treatment. Total accuracy for duplex US ranged from 0.90 to 0.97 depending on the reference standard used, whereas MR angiography was completely accurate (1.00) regardless of the standard definition. Our data strongly suggest that the accuracy of MR angiography for identifying failing grafts in the infrapopliteal circulation is equal to that of duplex US and superior to that of duplex US in cases of complex revascularization. MR angiography should be included in routine follow-up of patients undergoing infrapopliteal bypass surgery.

The new role of magnetic resonance imaging in the contemporary diagnosis of venous malformation: can it replace angiography?

Magnetic resonance imaging (MRI) is well accepted for the contemporary diagnosis of venous malformation (VM), providing hemodynamic and anatomic information on the lesion, including its relationship with surrounding tissues and organs. A total of 196 clinically suspected VM patients were reviewed retrospectively to assess the accuracy and reliability of MRI for the diagnosis of VM. Initial workup included MRI, duplex ultrasonography, and whole-body blood pool scintigraphy, along with additional transarterial lung perfusion scintigraphy and lymphoscintigraphic assessment when indicated. Phlebography or arteriography, or both, were generally reserved as a road map for the treatment. A total of 294 MRI findings for 196 patients were also compared with the matching duplex ultrasonography findings available for 178 patients and matching whole-body blood pool scintigraphy findings for 136 patients. The phlebographic findings available for 87 patients were also compared. Among the 196 patients with clinically suspected VM, 174 were confirmed as having VM by MRI with true-positive findings and 2 as false-positive findings by MRI (sensitivity, 98.9%; positive predictive value, 98.9%). MRI ruled out VM for 18 patients with true-negative findings, though 2 were false-negative (specificity, 90%; negative predictive value, 90.0%). Two positive and two false-negative findings of VM, made by MRI, were subsequently confirmed by angiography. Among the 87 patients for whom phlebographic findings were available, 73 were confirmed as true-positive diagnoses of VM, 1 as false-positive, 11 as true-negative, and 2 as false-negative (sensitivity, 97.3%; specificity, 91.7%; positive predictive value, 98.7%; negative predictive value, 84.6%). MRI is likely to modify the traditional role of angiography for the management of VM and become a new standard, at least for diagnosis. MRI also is an excellent parameter in the assessment of treatment results.

Validation of duplex ultrasonography in detecting competent and incompetent perforating veins in patients with venous ulceration of the lower leg.

Incompetent perforating veins play an important role in the etiologic mechanism of venous ulceration and recurrent varicose veins. The anatomic and functional status of the venous system can be evaluated by duplex ultrasonography. To determine the value of this technique in the identification of competent and incompetent perforating veins, a prospective study was performed. In patients who underwent subfascial exploration for venous ulceration of the lower leg, the preoperative findings of duplex ultrasonography were compared with the findings at surgical exploration. In 20 consecutive patients, 42 incompetent and 8 competent perforating veins were detected by duplex ultrasonography. During operation the location of all 50 perforating veins appeared to be predicted correctly. Eleven additional perforating veins that had not been detected by duplex ultrasonography were found during operation. The sensitivity and specificity of duplex ultrasonography in predicting the site of perforating veins at the medial side of the lower leg in our study were 79.2% and 100%, respectively, for incompetent perforating veins and 82% and 100%, respectively, for competent and incompetent perforating veins. These figures indicate that duplex-guided local exploration of the lower leg in patients with venous ulceration as a result of incompetent perforating veins would miss a substantial number of perforating veins, possibly leading to incomplete healing or recurrent ulceration.

Duplex ultrasonography: a noninvasive technique in monitoring of Le Veen shunt.

Monitoring of peritoneovenous Le Veen shunt by duplex ultrasonography was first performed in 1993 in 10 patients. The duplex signal was picked up selectively in the venous tube and the peak velocity was measured at forced inspiration. Thirty-two examinations were performed. Of these, 13 had follow-up examinations by other modalities (radionuclide imaging, shuntography, or surgical exploration), all of which confirmed the findings of duplex ultrasonography. Shuntography was avoided in all instances with a patent shunt. Duplex ultrasonography allows noninvasive assessment of Le Veen shunt patency and appears reliable for determining the need for invasive diagnostic modalities or surgical shunt correction.