Duplex Ultrasound Research Articles

Duplex Ultrasound in Evaluating Transplanted Renal Artery In-Stent Restenosis.

To evaluate the diagnosis performance of duplex ultrasound (DUS) in predicting transplanted renal artery (TRA) in-stent restenosis (ISR). In this retrospective study, 112 consecutive patients underwent stenting due to TRA stenosis. DUS were performed within 1 week after stenting for baseline value, and after ≥3 months follow-up for surveillance of ISR. The DUS measurements included peak systolic velocity (PSV) and PSV ratio of renal artery stent to iliac artery (RIR). Receiver operating characteristic (ROC) curves were applied to evaluate the diagnosis performance of DUS parameters in predicting ISR. There were 69 patients (28 men; age, 38.3 ± 15.1 years) who obtained 92 adequate paired DUS and CTA after stenting, which were classified as ISR group (26 TRAs) and non-ISR group (66 TRAs). There was no difference between the two groups for baseline DUS features, including PSVB and RIRB. The late DUS features including stent PSVL (475.5 vs 261.9 cm/s), RIRL (4.10 vs 2.18), and stent PSVL/PSVB (2.72 vs 1.14) were significantly higher in the ISR group than the non-ISR group (all P < .0001). Stent PSVL, RIRL, and PSVL/PSVB demonstrated comparable AUCs in predicting ISR. However, the sensitivity and specificity of PSVL/PSVB in predicting ISR were 92.3 and 93.5%, respectively, demonstrating higher specificity with equivalent sensitivity than PSVL and higher sensitivity with equivalent specificity than RIRL. DUS is an accurate technique to identify TRA-ISR. We suggest all patients should undergo DUS immediately after stenting to establish baseline value and aid in evaluating ISR at late follow-up.

Comparison between low molecular weight heparin and apixaban (direct oral anticoagulant) in the prophylaxis against venous thromboembolism after laparoscopic sleeve gastrectomy.

Like any major operation, sleeve gastrectomy (SG) has its reported postoperative complications. Among them are venous thromboembolic complications (VTE) that may predispose to mortality. Despite the proven efficacy of the traditional anticoagulants, such as low molecular weight heparins (LMWHs) for VTE management, they have their limitations. Direct oral anticoagulants (DOACs) have been currently adopted for the management of VTE. We conducted this study to evaluate the efficacy and safety of apixaban against VTE after laparoscopic sleeve gastrectomy in comparison with LMWH. This was a randomized controlled trial that included 100 adult patients who underwent SG and received LMWH (Group A) or apixaban (Group B) for VTE prophylaxis. We recorded and analyzed the postoperative events up to the 30th day after surgery. This study included Group A (n = 50) and Group B (n = 50). No VTE occurred in either group (0%). Postoperative bleeding was encountered in one patient of each group (2%). The follow-up venous Doppler study was unremarkable in the two groups. Apixaban was shown to be comparable to LMWH for the prevention of VTE after LSG with similar efficacy and safety making it a promising alternative to LMWH in patients undergoing bariatric surgery.

Role of shearing wave elastography in detecting early diabetic nephropathy.

Diabetes mellitus is one of the systemic diseases affecting the kidneys that eventually develop end-stage kidney disease. Shear wave elastography (SWE) is a reliable and non-invasive ultrasonography test used to determine tissue elasticity. The aim of this study is to detect early diabetic nephropathy by measuring renal stiffness using shear wave elastography (SWE), renal resistivity indices, and laboratory findings in DN patients. Shear wave elastography and color duplex sonography assessments were performed in 60 diabetic nephropathy patients (divided according to eGFR into 3 stages: stage I-II-III diabetic nephropathy with equal groups of 20 patients in each stage) and 20 healthy age-matched control subjects. The SWE-derived mean value of the tissue stiffness, given in kilopascals (kPa), was correlated to patients' clinico-laboratory data (serum creatinine and eGFR) and resistive index. There is a statistically significant increase in SWE and RI in the diabetic group than control group and a statistically significant increase in SWE (mean) in CKD stage II and III when compared with CKD stage I, SWE can be used to discriminate between diabetic groups and control group at a cutoff level of > 10.5 (kPa), and also, SWE (mean) can be used to discriminate between CKD stage II and III patients at a cutoff level of > 41 (kPa), with 66.7% sensitivity and 64.9% specificity. Shear wave elastography is a sensitive, non-invasive, and specific diagnostic tool for the detection of diabetic nephropathy and differentiation between different stages of DN.

Effectiveness of aspirin in preventing deep vein thrombosis following proximal femoral fracture surgery in Japan

Previous studies have shown that aspirin is effective as a prophylactic agent against venous thromboembolism (VTE) following proximal femoral fractures (PFF). In Japan, there is a lack of evidence regarding its efficacy and safety in this context. Consequently, aspirin is not covered by insurance for the prevention of venous thrombosis. This study aimed to investigate whether continued aspirin use in patients with PFF, who were already taking aspirin for cerebrovascular disease prevention before injury is effective as a prophylaxis for deep vein thrombosis (DVT). We retrospectively analyzed PFF patients (≥ 65 years) who underwent postoperative duplex ultrasonography from January 2010 to December 2023.The study compared patients taking aspirin alone (aspirin group) and those not taking antiplatelet agents or anticoagulants (control group), matched by propensity scores. We enrolled 1064 patients while 161 (15%) were in the aspirin group. After matching, 128 patients were analyzed. DVT incidence was not statistically significant between the aspirin (54) and control groups (60) (OR: 0.81; 95%CI: 0.49- 1.36; p = 0.44). Proximal DVT incidence was also similar (OR: 2; 95%CI: 0.50–7.00; p = 0.33). Additionally, since use of other postoperative antithrombotic prophylaxis (78%) is thought to have a significant impact on the incidence of DVT, a subgroup analysis was conducted to evaluate the effect of aspirin in patients who did not receive postoperative antithrombotic prophylaxis. Similarly, there was no statistically significant difference in either DVT (OR: 1.38; 95% CI: 0.55–3.42; p = 0.49) or proximal DVT (OR: 2.00; 95% CI: 0.37–10.92; p = 0.42). This study demonstrates that aspirin is not effective for preventing VTE in patients with PFF in Japan.

Exploration of pulse wave analysis under reactive hyperemia and close to an arteriovenous fistula: a comparative analysis.

Analyzing novel pulse wave parameters, we aimed to study specific changes in pulse waveform under high flow conditions in three collectives (i.e., healthy individuals and two collectives of patients with kidney disease and different levels of comorbidities): First, under reactive hyperemia in order to assess endothelial function. Second, close to an ateriovenous fistula in order to assess fistula function. Subjects underwent local peripheral tonometric pulse wave analysis with the SphygmoCor® device and duplex sonography to assess flow velocity (peak Vmax and diastolic Vdiast) under physiological conditions. Corresponding measurements were then performed under reactive hyperemia and at fistula arms. The area under the curve and the mean slope between the systolic peak and the end of systole of pulse waves and duplex flow velocities were analysed as parameter differences under high flow and physiological conditions (∆A2 and ∆m2, ∆Vmax and ∆Vdiast). In addition, the augmentation index was evaluated (only) under physiological conditions. The Wilcoxon test was used to assess parameter differences and linear correlation was performed. A total of 108 subjects were evaluated (23 healthy and 85 with fistula in two distinct collectives n = 39/45, measurements under reactive hyperemia in 62 individuals). Significant increments in the novel pulse parameters were observed under reactive hyperemia and near a fistula and were found to correlate with corresponding changes in flow velocity (reactive hyperemia: ∆A2 and ∆m2/Vmax r = 0.347, p = 0.006 and r = 0.374, p = 0.003; fistula: ∆A2/∆Vmax r = 0.315, p = 0.003, no significant correlation for ∆m2/Vmax). Consistent with their different vascular status and endothelial function, changes in pulse wave parameters during reactive hyperemia were significantly different in patients and healthy subjects. Both high flow conditions induced similar changes in the pulse waveform and a delay of the systolic peak in all three collectives. The augmentation index was different in the three collectives and correlated with the increase of the novel parameters and the peak flow velocity under reactive hyperemia: ∆A2 r = 0.445, p < 0.001, ∆m2 r = 0.338, p = 0.007, ∆Vmax r = 0.460. Detection of changes in pulse waveform under high flow conditions is potentially a new clinical application to characterize endothelial function and the functional status of ateriovenous fistulas.

Predictive value of renal shear wave elastography in liver cirrhosis

In 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. In 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). PI 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). Point-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.

A diagnostic comparison study between maximal systolic acceleration and acceleration time to detect peripheral arterial disease

Detecting peripheral arterial disease (PAD) can be particularly challenging in patients with diabetes mellitus (DM) or chronic kidney disease (CKD) due to medial arterial calcification (MAC). Current bedside tests, such as the ankle-brachial index, are less accurate in these patient groups. The primary aim of this study is to evaluate the diagnostic accuracy of point-of-care duplex ultrasound parameters maximal systolic acceleration (ACCmax) and acceleration time (AT) to detect PAD, including a comparison of both metrics. Patients suspected of having PAD, who underwent point-of-care duplex ultrasound measurements (ACCmax and AT) of the posterior tibial artery (PTA) and/or anterior tibial artery (ATA) at ankle level along with computed tomography angiography were eligible for inclusion. PAD was defined as a stenosis >50% on computed tomography angiography. Diagnostic accuracy of AT was evaluated at calculated (Youden index) and prespecified cut-off values (121ms), using the sensitivity, specificity, positive likelihood ratio, negative likelihood ratios, and area under the curve. The McNemar test compared ACCmax with AT at prespecified and calculated cut-off values. Subgroup analyses of patients prone to MAC (i.e., those with DM and/or CKD) were also performed. This study included 184 patients (267 legs) with a high prevalence of DM (53%) and CKD (36%). The diagnostic accuracy of AT to identify PAD for PTA showed a sensitivity of 84%, specificity of 98%, positive likelihood ratio of 42.00, negative likelihood ratio of 0.16 and area under the curve of 0.96. Regarding the ATA, the results were 81%, 93%, 11.57, 0.20, and 0.92, respectively. Statistical comparisons favored ACCmax over AT in detecting PAD at prespecified and calculated cut-off values for both the PTA and ATA (P<0.001). Additionally, in patients prone to MAC, ACCmax also outperformed AT in detecting PAD (P values ranging from <0.001 to 0.039). For patients without PAD, no significant differences were observed in the ability to rule out the disease. ACCmax proved to be more accurate than AT in detecting PAD, also in patients prone to MAC. While no significant difference was found between ACCmax and AT in their diagnostic accuracy to exclude PAD, ACCmax should be favored in the diagnostic work-up in patients suspected of PAD due to its superior ability to detect an arterial stenosis.

Assessing the Predictive Value of the Neutrophil-to-Lymphocyte Ratio for Post-Thrombotic Syndrome following Iliofemoral Deep Venous Thrombosis

Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) that occurs in 20-50% of patients and results in a decreased quality of life. Even with the progressive identification of PTS risk factors, clinically useful predictors of PTS continue to be limited, unobjective, and ill-defined. The neutrophil-to-lymphocyte ratio (NLR) is an emerging prognostic biomarker used in a variety of diseases that reflects acute systemic inflammation. This pilot study aimed to evaluate the utility of the NLR at the time of iliofemoral DVT diagnosis in predicting PTS incidence in patients. A retrospective chart review was performed on patients identified with iliofemoral DVT at the University of Maryland Medical Center between 2020 and 2022. Patients with at least one follow-up visit between 3 and 6months after initial DVT diagnosis were included. Diagnosis of PTS was determined based on Villalta Score. The Youden index with receiver operating characteristic curve analysis was used to determine the NLR cut-off value that may be predictive of PTS. A multivariable logistic regression model was then performed to assess the utility of this NLR cut-off value and other common clinical markers in predicting the presence of PTS symptoms. Four hundred and eighteen patients with positive iliofemoral DVT venous duplex ultrasounds were screened for eligibility. One hundred and eighteen patients were eligible with a mean age of 53.18±15.45years. A total of 43 patients (36.44%) were found to have PTS. An NLR cut-off of 7.71 was determined with an area under the receiver operating characteristic curve (area under the curve) of 0.63 (P=0.046). When the NLR was assessed jointly with other clinical markers at the time of DVT diagnosis, NLR was a statistically significant positive predictor, measured using odds ratio (1.83; 95% confidence interval, 1.20-2.78; P=0.005). Our study found that when stratified by a determined cutoff value, the NLR at the time of DVT diagnosis was significantly associated with the development of PTS in patients with iliofemoral DVT. This result is consistent with one prior research finding yet is novel in its specificity for iliofemoral DVTs and its acute lab collection for NLR calculation. The NLR should be further investigated as a potential inexpensive prognostic tool to aid in the improvement of treatment and prophylactic strategies for PTS.

Correlation of Imaging Characteristics of Carotid Plaque with Clinical and Histopathological Features and Application of Artificial Intelligence Techniques in Identifying Carotid Disease

Introduction: Stroke is the third-leading cause of death. Carotid artery stenosis (CAS) accounts for 8%–37% of strokes. Landmark carotid trials have shown carotid endarterectomy (CEA) superior to best medical therapy (BMT) for symptomatic moderate stenosis and asymptomatic high-grade stenosis. This study aims to correlate imaging characteristics of vulnerable plaque (VP) with clinical and histopathological features and to assess the ability of artificial intelligence (AI) techniques to identify VP and disease burden using duplex ultrasound (DU) data. Materials and Methods: This prospective study from August 2022 to April 2024 used DU and computerized tomographic angiography (CTA) or magnetic resonance angiography (MRA) to assess carotid plaques in patients planned for CEA and subjected plaques to histology. We also imaged carotid plaques using DU in asymptomatic patients on BMT. YOLOv8 deep learning and U-Net AI models were used to analyze ultrasound (US) images. Results: One hundred and fiftyOne hundred and fifty patients were included in the study. Sixty (40%) were symptomatic. The age range was 33–84 years (mean 58.9). One hundred and fifteen (76.7%) were males. Hypertension, diabetes, dyslipidemia, and smoking were seen in 59%, 56%, 49%, and 40%, respectively and were more prevalent in patients with VP (90%, 60%, 70%, and 50%). Of the 70 patients who underwent CEA, 60 were symptomatic and 10 asymptomatic. 70% of symptomatic patients had a RANKIN (mRS) score of 2–3. All surgical patients underwent DU, 49 CTA, and 21 MRA. Based on the US, 53/60 (88%) symptomatic patients had VP. 56/60 (93%) were confirmed VP on histology. Positive predictive value (PPV) for VP was highest for DU (95%), followed by MRA (89%) and CTA (73%). PPV of DU screening in operated asymptomatic patients was 100%. AI showed 96% PPV for identifying &gt;50% stenosis. Model training in identifying VP accuracy increased from 0.73 to 0.94 metrics. Conclusion: DU is an excellent modality to identify the nature of carotid plaque and can be a good tool to identify VP in asymptomatic CAS. More data will improve AI accuracy.

Incidence, Predictors, and Management of Femoral Vascular Complications Following Catheter Ablation for Atrial Fibrillation: A Systematic Duplex Ultrasound Study

Background/Objectives: Catheter ablation is an effective treatment for atrial fibrillation (AF) but is associated with femoral vascular complications. While anticoagulation therapy has been linked to these complications, specific risk factors remain unclear. This study assessed the incidence and predictors of vascular complications after catheter ablation using systematic duplex ultrasound (DUS) as well as their outcomes. Methods: A single-center observational study was conducted with 404 consecutive AF patients who underwent catheter ablation between March 2023 and February 2024. DUS was performed systematically post-procedure in all patients to identify complications; these were primarily treated with DUS-guided manual compression. Results: Vascular complications were observed in 6.4% of patients, higher than reported in previous studies. Hematomas (3.5%) and arteriovenous fistulas (AVFs, 2.0%) were the most common such complications. Multivariate analysis identified repeat ablation (odds ratio [OR] 3.09, 95% confidence interval [CI] 1.10–8.64, p = 0.03) and months of experience &lt;6 months (OR 3.42, 95% CI 1.36–8.63, p = 0.01) as significant predictors of complications. DUS-guided compression managed most complications successfully, with three pseudoaneurysms resolved through compression and one through embolization. However, AVFs were relatively resistant to conservative management, often necessitating prolonged observation or intervention. Conclusions: Systematic DUS following catheter ablation revealed a higher-than-expected incidence of vascular complications. Repeat ablation and months of experience &lt;6 months are potential predictors of femoral vascular complications. DUS-guided compression is effective for most complications, although AVFs present greater treatment challenges.

Point-of-Care Ultrasound in Nephrology: Beyond Kidney Ultrasound

Point-of-care ultrasound (POCUS) has increasingly become an integral part of clinical practice, particularly in nephrology, where its use extends beyond renal assessment to include multi-organ evaluations. Despite challenges such as limited ultrasound training and equipment access, especially in low- and middle-income countries, the adoption of POCUS is steadily rising. This narrative review explores the growing role of multi-organ POCUS in nephrology, with applications ranging from the assessment of congestion phenotypes, cardiorenal syndrome, and hemodynamic acute kidney injury (AKI) to the evaluation of arteriovenous fistulas and electrolyte disorders. In nephrology, POCUS enhances clinical decision making by enabling rapid, bedside evaluations of fluid status, cardiac function, and arteriovenous access. Studies have demonstrated its utility in diagnosing and managing complications such as heart failure, cirrhosis, and volume overload in end-stage renal disease. Additionally, POCUS has proven valuable in assessing hemodynamic alterations that contribute to AKI, particularly in patients with heart failure, cirrhosis, and systemic congestion. This review highlights how integrating ultrasound techniques, including lung ultrasound, venous Doppler, and focused cardiac ultrasound, can guide fluid management and improve patient outcomes. With advancements in ultrasound technology, particularly affordable handheld devices, and the expansion of targeted training programs, the potential for POCUS to become a global standard tool in nephrology continues to grow, enabling improved care in diverse clinical settings.

Acute Kidney Injury Due to Ureter Compression Following Iliac Venous Stenting.

To report the occurrence of acute postrenal kidney failure caused by external ureteral obstruction after iliac venous stent placement. A 73-year-old male patient presented with a chronic swelling and feeling of heaviness of his right leg. The presence of venous thrombosis was excluded by duplex ultrasound (DUS). However, DUS revealed a high-grade non-thrombotic stenosis of the right external iliac vein which was confirmed by computed tomography venography. This stenosis was attributed to local scarring following prostatectomy, lymphadenectomy, and adjuvant radiation therapy for prostate cancer 7 years before. According to the clinical presentation, the patient underwent catheter-based revascularization by implantation of a dedicated venous stent in the external iliac vein. One day after this procedure, the patient experienced acute kidney failure, which was attributable to an incipient right-sided grade II hydronephrosis. Subsequent ureterorenoscopy demonstrated a stenotic lesion of the intermediate part of the ureter at the same level as the venous stent. Finally, ureteral stent placement resulted in the restoration of urinary drainage as well as resolution of acute kidney failure. This case report highlights the importance of considering nonvascular complications after venous stent placement and it stresses the importance of postprocedural clinical and laboratory surveillance and follow-up. In recent years the number of endovenous stent implantations has significantly increased. In patients with clinically relevant iliofemoral obstructions, endovenous stent placement potentially reduces related symptoms and improves quality of life. However, endovenous stent placement may have an impact on peri-vascular structures, such as the ureters. This case report highlights the awareness of potential nonvascular complications, which might be caused by iliofemoral stent implantation.

Evaluation of in-stent restenosis after carotid artery stenting with superb microvascular imaging: initial findings.

Carotid artery stenting (CAS) is an interventional management in preventing ischemic stroke caused by carotid artery stenosis. After the treatment with CAS, in-stent restenosis caused by neointimal hyperplasia may develop. This study aims to obtain a better determination of neointimal hyperplasia using superb microvascular imaging (SMI), which provides a high-quality visualization of the endoluminal lesions, and to compare these results with B-mode and Doppler ultrasound (US). A total of 106 patients who underwent CAS in our interventional radiology unit between 2018 and 2020 were retrospectively analyzed. In total, 44 patients whose procedure images and post-procedural follow-up Doppler US and SMI data could be accessed were included. There were nine patients who had in-stent restenosis. One patient had no velocity increase; however, on SMI the measurements showed in-stent restenosis both in area and diameter. The other eight patients had a stenosis degree in the range of 50%-79% on Doppler US. Five patients had in-stent restenosis, both in Doppler US and SMI, by area and diameter measurements. Two patients underwent digital subtraction angiography (DSA). We suggest that using SMI with duplex sonography improves detecting neointimal hyperplasia and in-stent restenosis. With SMI, better visualization of the stent lumen may improve the patient selection for DSA.

Regional changes in cerebral blood flow between the upright and supine posture and over 3 days of bed rest.

A reduction in cerebral blood flow (CBF) has been observed during spaceflight and bed rest.We aimed to examine the magnitude and regional heterogeneity of the decrease in CBF during bed rest compared to posture changes on Earth. Seventeen participants (age, 29±9years, 7 females) were studied in the upright and supine posture and over 3days of bed rest. We assessed blood flow via duplex ultrasonography in the internal carotid (ICA) and vertebral arteries (VA), and via transcranial Doppler of the middle cerebral artery (MCAv). Mean arterial pressure (MAP) and end-tidal CO2 ( ) were assessed at all time points. By day 3, total CBF (1078±302 to 853±245mLmin-1, P<0.0001) and MCAv (61±15 to 49±12mLmin-1, P<0.0001) were decreased compared to the supine posture. CBF values did not fall below the upright posture (all P>0.05) but were lower than a calculated 24-h mean baseline (P=0.0132). MAP remained stable (P=0.971), as did (P=0.0803), while VA blood flow decreased after 24h and again after 72h (P=0.0024). These findings indicate that CBF decreases during short-term bed rest, but not below values observed in the upright posture.

Variation in compressive mechanical properties between subacute and chronic venous thrombosis in a novel unilateral iliac thrombosis model.

Background: Interventional therapies to relieve chronic deep vein thrombosis (DVT) fail through inability to penetrate, cross, and remove the occlusion. Development of suitable tools requires fundamental understanding of chronic DVT mechanical properties and a reliable model for testing. Methods: Female farm swine underwent a novel, endovenous generation of long-segment unilateral iliac vein thrombosis. Thrombus was confirmed via venogram, intravascular ultrasound, and transabdominal duplex for 14 days. Thrombus components were quantified via histology. Thrombus mechanical properties were assessed via uniaxial compression. Results: Among seven swine, technical success was 100%. Compared to subacute thrombi (7-day), chronic thrombi (14-day) showed organizing thrombus with diffuse myointimal thickening and collagen matrix formation on histology. The thrombi collagen content was 41% versus 55% (p = 0.17) and the thrombus erythrocyte percentage was 4.3% versus 2.2%, p = 0.21 in 7- versus 14-day thrombi, respectively. The onset point (compression required to load the thrombus fiber network) was 66.6% versus 35.3% (p = 0.004), the secant modulus (resistance to deformation) measured at the onset point was 153.8 versus 275.99 kPa (p = 0.18), and the average shear constant (resistance to shearing), as defined by the Yeoh hyperelastic model, was 1.85 kPa versus 2.85 kPa in 7- versus 14-day thrombi. Conclusions: This study demonstrates the feasibility of an endovenous model generating chronic unilateral venous thrombi in 2 weeks with similar anatomy to humans and provides critical mechanical properties of thrombi for future research.

Safety of accessing brachial veins for large-bore upper extremity venous thrombectomy using ClotTriever Thrombectomy System

PurposeTo evaluate access site adverse events following ClotTriever-mediated large-bore mechanical thrombectomy via small upper extremity deep veins (< 6-mm).Materials and methodsTwenty patients, including 24 upper extremity venous access sites, underwent ClotTriever-mediated large-bore thrombectomy of the upper extremity and thoracic central veins for symptomatic deep vein obstruction unresponsive to anticoagulation. Patients without follow-up venous duplex examinations (n = 3) were excluded. Patients who had > 6-mm diameter veins accessed (n = 3) were excluded. Temporary purse-string sutures and manual pressure were used for access site hemostasis in all patients. Vein access site and diameter, technical success (defined as placement of the 13.5-French ClotTriever sheath followed by thrombectomy), and early (< 30-days) and late (> 30-days) access site-related adverse events (according to the Adverse Event Classification by the Society of Interventional Radiology criteria) were recorded.ResultsFourteen patients (8 males, 6 females; mean age 51.7 ± 13.6 years) comprising 16 upper extremity venous access sites were included in this study. Access sites included: right brachial (n = 7), left brachial (n = 5), and bilateral brachial (n = 2) veins. The mean access site diameter was 4.3-mm ± 0.67-mm. Technical success was achieved via all access sites. Six (42.9%) patients underwent stent reconstruction following thrombectomy through the same accesses. After the procedure, all purse-string sutures were removed within 24 h. Three (21.4%) patients experienced small access site hematomas that did not require transfusion, intervention, or prolonged hospitalization. Initial follow-up venous duplex ultrasounds were performed at 29.3 ± 21.7 days following intervention. The mean follow-up interval to the second and third venous duplex ultrasounds were 124.3 ± 64-days and 225.1 ± 80.1 days, respectively. One (7.1%) patient developed right arm swelling six days after the procedure and was found to have thrombosis of the previously accessed right brachial vein. No other clinically or sonographically significant access site adverse events were observed.ConclusionClotTriever-mediated large-bore thrombectomy via small upper extremity veins is safe with minimal access site adverse events.

Neuro-POCUS and transcranial ultrasound (history, basics and prospects)

Neuro-POCUS (Point-of-Care Ultrasound in neurology) is the international abbreviation for a new strategic direction in neuromedicine. It provides the clinician with a unique opportunity to perform neuroimaging themselves during patient examination or surgical manipulation to solve specifi c practical problems. In the domestic literature, the term «clinical-sonographic examination» was proposed for this approach. This direction is of particular importance in screening diagnosis, monitoring and surgical navigation in the most frequent and dangerous structural intracranial changes (hematomas, tumors, cysts, hydrocephalus, etc.). For the development of Neuro-POCUS technologies, an international scientifi c group was established in 2022, according to the report of which the assessment of brain parenchyma is discussed in the framework of monitoring midline shift and third ventricle width and mainly using transcranial color-coded duplex sonography. A review of the literature and our own 30 years of research suggest that B-mode transcranial ultrasonography is the optimal option for brain imaging within Neuro-POCUS. The history, foundations and prospects of Neuro-POCUS are discussed.

Expert-Based Narrative Review on Compression UltraSonography (CUS) for Diagnosis and Follow-Up of Deep Venous Thrombosis (DVT).

Deep venous thrombosis (DVT) is a pathological condition that develops when a thrombus forms within the deep venous system. Typically, it involves the lower limbs and, less frequently, the upper extremities or other unusual districts such as cerebral or splanchnic veins. While leg DVT itself is rarely fatal and occasionally can lead to limb-threatening implications, its most fearsome complication, namely pulmonary embolism, is potentially fatal and significantly contributes to increased healthcare costs and impaired quality of life in affected patients and caregivers. Thanks to its high accuracy, ease of use, and safety profile, duplex ultrasound (DUS), particularly compression ultrasound (CUS), has emerged as the first-line imaging modality for DVT diagnosis. The evaluation of suspected DVT needs a multifaceted approach, and in this context, CUS rapidly became a key diagnostic tool owing to its many unique advantages. Its central role in the diagnostic algorithm of suspected DVT is clearly established in the latest clinical practice guidelines from the European Society for Vascular Surgery and the American Society of Haematology. Indeed, DUS effectively visualizes blood flow and identifies abnormalities like clot formation with high sensitivity (typically exceeding 90% for proximal DVT) and specificity (often approaching 100% for proximal DVT). Additionally, CUS is non-invasive, readily available at the bedside, and avoids radiation exposure, resulting in an ideal method for various clinical settings. CUS has been shown to have a substantial role not only in the diagnosis of an acute DVT but also in the follow-up of its management. Moreover, this method can provide a prognostic assessment, mostly in terms of risk stratification for recurrent thrombosis and/or for potential complications, such as post-thrombotic syndrome. In summary, given its established benefits, CUS is a technique that many physicians should be familiar with, especially those working in emergency departments, intensive care units, or general wards. When needed, healthcare operators with more advanced US skills (such as radiologists, angiologists, or vascular surgeons) may be called upon to provide a second look in case of uncertainty and/or need for additional information.

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. 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.

Hand acceleration time (HAT) as a diagnostic tool in the assessment of haemodialysis access-induced distal ischaemia (HAIDI): study protocol for a prospective cohort study in the Barcelona south metropolitan area

IntroductionChronic hand ischaemia may affect some haemodialysis patients with an arteriovenous fistula (AVF) or graft (AVG), a condition known as haemodialysis access-induced distal ischaemia (HAIDI). Duplex ultrasonography (DUS) can provide...