Pub Date : 2024-06-03DOI: 10.1177/15443167241257218
Erika Carrion
Herein, we present a case study of a patient with suspected transient ischemic attacks who was referred to the vascular laboratory for an assessment of the extracranial cerebrovascular arteries. Duplex ultrasound revealed momentary flow reversal in the right common carotid artery and internal carotid artery. Reverse flow in the right vertebral artery and a dampened Doppler waveform in the right subclavian artery were suggestive of a subclavian steal syndrome. These findings were consistent with innominate artery (IA) stenosis or occlusion. This case study is confirmatory evidence that indirect sonographic techniques can reliably identify IA occlusive disease.
{"title":"Indirect Duplex Ultrasound Diagnosis of Innominate Artery Occlusive Disease","authors":"Erika Carrion","doi":"10.1177/15443167241257218","DOIUrl":"https://doi.org/10.1177/15443167241257218","url":null,"abstract":"Herein, we present a case study of a patient with suspected transient ischemic attacks who was referred to the vascular laboratory for an assessment of the extracranial cerebrovascular arteries. Duplex ultrasound revealed momentary flow reversal in the right common carotid artery and internal carotid artery. Reverse flow in the right vertebral artery and a dampened Doppler waveform in the right subclavian artery were suggestive of a subclavian steal syndrome. These findings were consistent with innominate artery (IA) stenosis or occlusion. This case study is confirmatory evidence that indirect sonographic techniques can reliably identify IA occlusive disease.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20DOI: 10.1177/15443167241246116
Akash D. Nijhawan, Austin J. Pourmoussa, Bradley R. Fox, Samuel A. Salazar, Charles J. Lugo, Muhammad Hasan, James F. Benenati, Brian J. Schiro
Surveillance for endoleak after endovascular aortic aneurysm repair with computed tomography angiography has the associated risks of radiation exposure and nephrotoxic contrast agents. The purpose of this study was to evaluate the performance of contrast-enhanced ultrasound in the detection of endoleak post–endovascular aortic aneurysm repair. A single-center retrospective cohort study was performed evaluating patients with abdominal aortic aneurysm treated with endovascular aortic aneurysm repair between October 29, 2017 and April 21, 2021 and follow-up imaging with both computed tomography angiography and contrast-enhanced ultrasound. The sample included 35 imaging combinations in 28 patients. Positive and negative results for detection of endoleak by contrast-enhanced ultrasound were tabulated as true positive, false positive, true negative, and false negative compared to computed tomography angiography and conventional angiography. Sensitivity, specificity, positive predictive value, and negative predictive value of contrast-enhanced ultrasound were calculated. Out of 35 imaging combinations, endoleak was detected in 24 cases by computed tomography angiography and in 23 cases by contrast-enhanced ultrasound. Using computed tomography angiography as the reference standard, contrast-enhanced ultrasound yielded 96% sensitivity, 100% specificity, 100% positive predictive value, and 92% negative predictive value for endoleak detection. In the 23 cases of endoleak detection by both contrast-enhanced ultrasound and computed tomography angiography, contrast-enhanced ultrasound discerned the correct endoleak type in all 23 cases, while computed tomography angiography identified the correct endoleak type in 20 cases ( P = .2333). Endoleak detection by contrast-enhanced ultrasound appears at least equivalent to computed tomography angiography. Some of the advantages of contrast-enhanced ultrasound in the surveillance of endoleak after endovascular aortic aneurysm repair include an avoidance of radiation, elimination of nephrotoxic contrast agents, reduction in costs, real-time imaging, discerning flow directionality, and visualizing endoleaks in regions previously embolized with coils/plugs/liquid embolic agents. Limitations include operator dependence and variables that obscure the visual field including obese body habitus. With these advantages and excellent comparison data, contrast-enhanced ultrasound should be considered as a first-line imaging modality for long-term surveillance of endoleaks after endovascular aortic aneurysm repair. Contrast-enhanced ultrasound is a safe and viable option for long-term surveillance post–endovascular aortic aneurysm repair.
{"title":"Single-Center Retrospective Study on the Efficacy of Contrast-Enhanced Ultrasound for Detection of Endoleak After Endovascular Aortic Repair","authors":"Akash D. Nijhawan, Austin J. Pourmoussa, Bradley R. Fox, Samuel A. Salazar, Charles J. Lugo, Muhammad Hasan, James F. Benenati, Brian J. Schiro","doi":"10.1177/15443167241246116","DOIUrl":"https://doi.org/10.1177/15443167241246116","url":null,"abstract":"Surveillance for endoleak after endovascular aortic aneurysm repair with computed tomography angiography has the associated risks of radiation exposure and nephrotoxic contrast agents. The purpose of this study was to evaluate the performance of contrast-enhanced ultrasound in the detection of endoleak post–endovascular aortic aneurysm repair. A single-center retrospective cohort study was performed evaluating patients with abdominal aortic aneurysm treated with endovascular aortic aneurysm repair between October 29, 2017 and April 21, 2021 and follow-up imaging with both computed tomography angiography and contrast-enhanced ultrasound. The sample included 35 imaging combinations in 28 patients. Positive and negative results for detection of endoleak by contrast-enhanced ultrasound were tabulated as true positive, false positive, true negative, and false negative compared to computed tomography angiography and conventional angiography. Sensitivity, specificity, positive predictive value, and negative predictive value of contrast-enhanced ultrasound were calculated. Out of 35 imaging combinations, endoleak was detected in 24 cases by computed tomography angiography and in 23 cases by contrast-enhanced ultrasound. Using computed tomography angiography as the reference standard, contrast-enhanced ultrasound yielded 96% sensitivity, 100% specificity, 100% positive predictive value, and 92% negative predictive value for endoleak detection. In the 23 cases of endoleak detection by both contrast-enhanced ultrasound and computed tomography angiography, contrast-enhanced ultrasound discerned the correct endoleak type in all 23 cases, while computed tomography angiography identified the correct endoleak type in 20 cases ( P = .2333). Endoleak detection by contrast-enhanced ultrasound appears at least equivalent to computed tomography angiography. Some of the advantages of contrast-enhanced ultrasound in the surveillance of endoleak after endovascular aortic aneurysm repair include an avoidance of radiation, elimination of nephrotoxic contrast agents, reduction in costs, real-time imaging, discerning flow directionality, and visualizing endoleaks in regions previously embolized with coils/plugs/liquid embolic agents. Limitations include operator dependence and variables that obscure the visual field including obese body habitus. With these advantages and excellent comparison data, contrast-enhanced ultrasound should be considered as a first-line imaging modality for long-term surveillance of endoleaks after endovascular aortic aneurysm repair. Contrast-enhanced ultrasound is a safe and viable option for long-term surveillance post–endovascular aortic aneurysm repair.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"75 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20DOI: 10.1177/15443167231210359
Fanilda Souto Barros, J. Storino
Diameter has been a complementary measurement in the evaluation of venous valvular insufficiency of superficial veins of the lower extremity. Small veins with reflux or large veins without reflux may indicate alternative treatments. Awareness of pelvic vein reflux is increasing. The pelvic vein diameter-reflux relationship was investigated. Findings of lower extremity ultrasound (US) and/or clinical conditions—pelvic pain, dyspareunia and dysmenorrhoea—were indications for pelvic/abdominal venous US. Complete US examination included renal, internal iliac and gonadal/ovarian veins. Diameters of the largest right or left pelvic veins were compared with presence of reflux. Intravaginal US was completed in 104 women, age 46 ± 11 (standard deviation) (range 25-76) years old. Pelvic symptoms were reported by 30 (29%) patients. The other patients had pelvic-related recurrent varicose veins or suspected pelvic source of lower extremity venous reflux. Positive and negative predictive values (PPV, NPV) and other statistics at the 90-95% level were calculated relating diameter to pelvic vein reflux. Pelvic vein reflux was detected in 54 (52%) women. Pelvic vein diameters were larger in refluxing, 8.4 ± 1.9 (5.1-14.0) mm, than in nonrefluxing veins, 5.2 ± 1.0 (3.4-8.3) mm ( P < .001 by t test). Diameters ≥6.3 mm had 91% (49/54) sensitivity and 92% (49/53) PPV. Diameters ≤6.3 mm had 94% specificity (47/50) and 89% (47/53) NPV. All veins with diameter ≥8.4 mm ( n = 21) had reflux. All veins with diameter ≤5.0 mm ( n = 27) did not have reflux. Probabilities of pelvic vein reflux were estimated based on diameters. Diameter-reflux agreement solidifies diagnosis. An explanation for contradiction between small diameter and reflux or large diameter and no reflux is recommended.
{"title":"Relationship Between Diameter and Pelvic Vein Reflux","authors":"Fanilda Souto Barros, J. Storino","doi":"10.1177/15443167231210359","DOIUrl":"https://doi.org/10.1177/15443167231210359","url":null,"abstract":"Diameter has been a complementary measurement in the evaluation of venous valvular insufficiency of superficial veins of the lower extremity. Small veins with reflux or large veins without reflux may indicate alternative treatments. Awareness of pelvic vein reflux is increasing. The pelvic vein diameter-reflux relationship was investigated. Findings of lower extremity ultrasound (US) and/or clinical conditions—pelvic pain, dyspareunia and dysmenorrhoea—were indications for pelvic/abdominal venous US. Complete US examination included renal, internal iliac and gonadal/ovarian veins. Diameters of the largest right or left pelvic veins were compared with presence of reflux. Intravaginal US was completed in 104 women, age 46 ± 11 (standard deviation) (range 25-76) years old. Pelvic symptoms were reported by 30 (29%) patients. The other patients had pelvic-related recurrent varicose veins or suspected pelvic source of lower extremity venous reflux. Positive and negative predictive values (PPV, NPV) and other statistics at the 90-95% level were calculated relating diameter to pelvic vein reflux. Pelvic vein reflux was detected in 54 (52%) women. Pelvic vein diameters were larger in refluxing, 8.4 ± 1.9 (5.1-14.0) mm, than in nonrefluxing veins, 5.2 ± 1.0 (3.4-8.3) mm ( P < .001 by t test). Diameters ≥6.3 mm had 91% (49/54) sensitivity and 92% (49/53) PPV. Diameters ≤6.3 mm had 94% specificity (47/50) and 89% (47/53) NPV. All veins with diameter ≥8.4 mm ( n = 21) had reflux. All veins with diameter ≤5.0 mm ( n = 27) did not have reflux. Probabilities of pelvic vein reflux were estimated based on diameters. Diameter-reflux agreement solidifies diagnosis. An explanation for contradiction between small diameter and reflux or large diameter and no reflux is recommended.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"91 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-10DOI: 10.1177/15443167231210357
James Chen, Kane Smith, Qian Xu, Tshura Ali, Rodrigo Cavallazzi, S. Ghafghazi, S. Clifford, Forest W. Arnold, Maiying Kong, Jiapeng Huang
To investigate the longitudinal effects of COVID-19 on major vascular structures and parameters and clinical outcomes. Observational prospective trial. Post-COVID-19 research clinic established by University of Louisville Division of Infectious Diseases. The study population consisted of 72 post-COVID-19 individuals and 11 non-COVID-19 infected participants in the control group. The participants were recruited from adult hospitals and from the community. The enrollment started in October 2020 and follow-up periods were at 3, 6, and 12 months from their initial COVID-19 diagnosis. The participants were interviewed for medical and COVID-19 infection history. Samples of white blood cell (WBC), C-reactive protein (CRP), and D-dimer were taken at each visit. Certified sonographers performed vascular ultrasound on the study participants. Median intima-media thickness (IMT) was increased in mild/asymptomatic (0.80 mm) and severe/critical (0.90 mm) groups when compared with controls (0.60 mm; P < .001 for both groups). In the asymptomatic/mild group, 6-month median IMT (0.88 mm) was increased, compared with the 3-month group (0.75 mm), with P = .026. Increased age was associated with decreased mean arterial blood velocities (cm/s): common carotid ( r = −0.236, P = .032), internal carotid ( r = −0.208, P = .048), and subclavian artery mean velocity ( r = −0.357, P = .003). We did not find any instance of deep vein thrombosis. Median D-dimer, CRP, and WBC in the control group differed from asymptomatic/mild COVID-19 group ( P = .026, .011, and .003, respectively). Moreover, WBC in the asymptomatic/mild group and moderate COVID-19 group differed from severe/critical group ( P = .025 and P = .027, respectively); CRP also differed between asymptomatic/mild group and severe/critical group ( P = .014). There were differences in intima-media lumen thickness (IMT), arterial velocities, and inflammatory markers in post-COVID-19 patients. There was no instance of deep vein thrombosis in this post-COVID-19 study cohort. The increased IMT might infer atherosclerosis, which has shown to increase cardiovascular risks. It is not yet known whether the increase in IMT due to COVID should be treated in the same way as non-COVID-19 atherosclerosis—through statins, for example—or whether regular cardiovascular risk reduction would be useful. Clinical trial and mechanistic studies should be performed to further our understanding of COVID-19-related vascular pathologies.
{"title":"Long-term Effects of COVID-19 on Vascular Parameters—A Prospective Longitudinal Ultrasound Clinical Study","authors":"James Chen, Kane Smith, Qian Xu, Tshura Ali, Rodrigo Cavallazzi, S. Ghafghazi, S. Clifford, Forest W. Arnold, Maiying Kong, Jiapeng Huang","doi":"10.1177/15443167231210357","DOIUrl":"https://doi.org/10.1177/15443167231210357","url":null,"abstract":"To investigate the longitudinal effects of COVID-19 on major vascular structures and parameters and clinical outcomes. Observational prospective trial. Post-COVID-19 research clinic established by University of Louisville Division of Infectious Diseases. The study population consisted of 72 post-COVID-19 individuals and 11 non-COVID-19 infected participants in the control group. The participants were recruited from adult hospitals and from the community. The enrollment started in October 2020 and follow-up periods were at 3, 6, and 12 months from their initial COVID-19 diagnosis. The participants were interviewed for medical and COVID-19 infection history. Samples of white blood cell (WBC), C-reactive protein (CRP), and D-dimer were taken at each visit. Certified sonographers performed vascular ultrasound on the study participants. Median intima-media thickness (IMT) was increased in mild/asymptomatic (0.80 mm) and severe/critical (0.90 mm) groups when compared with controls (0.60 mm; P < .001 for both groups). In the asymptomatic/mild group, 6-month median IMT (0.88 mm) was increased, compared with the 3-month group (0.75 mm), with P = .026. Increased age was associated with decreased mean arterial blood velocities (cm/s): common carotid ( r = −0.236, P = .032), internal carotid ( r = −0.208, P = .048), and subclavian artery mean velocity ( r = −0.357, P = .003). We did not find any instance of deep vein thrombosis. Median D-dimer, CRP, and WBC in the control group differed from asymptomatic/mild COVID-19 group ( P = .026, .011, and .003, respectively). Moreover, WBC in the asymptomatic/mild group and moderate COVID-19 group differed from severe/critical group ( P = .025 and P = .027, respectively); CRP also differed between asymptomatic/mild group and severe/critical group ( P = .014). There were differences in intima-media lumen thickness (IMT), arterial velocities, and inflammatory markers in post-COVID-19 patients. There was no instance of deep vein thrombosis in this post-COVID-19 study cohort. The increased IMT might infer atherosclerosis, which has shown to increase cardiovascular risks. It is not yet known whether the increase in IMT due to COVID should be treated in the same way as non-COVID-19 atherosclerosis—through statins, for example—or whether regular cardiovascular risk reduction would be useful. Clinical trial and mechanistic studies should be performed to further our understanding of COVID-19-related vascular pathologies.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":" 57","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140990863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-10DOI: 10.1177/15443167241249246
William Del Valle
The toe-brachial index is typically an adjunctive examination to the ankle-brachial index, which has long been the primary physiologic modality for diagnosing peripheral arterial disease. The goal of this project was to determine toe-brachial index reliability, particularly with patients with diabetes. We compared duplex ultrasound to the ankle-brachial index and toe-brachial index on 100 patients (200 legs) with suspected symptomatic peripheral arterial disease. Duplex ultrasound stenosis in the femoral/popliteal/infrapopliteal arteries was at least a doubling of velocity between adjacent segments. A blunted systolic Doppler waveform was consistent with proximal occlusive disease. Normal physiologic ranges were arbitrarily set as ankle-brachial index 1.2 to 0.9 and toe-brachial index 0.9 to 0.5. We calculated overall sensitivity/specificity values by averaging. Both physiologic modalities had overall low sensitivity (ankle-brachial index 62%, toe-brachial index 56%). In diabetics, ankle-brachial index sensitivity was 61% and toe-brachial index sensitivity was 57%. Sensitivity improved in the presence of inflow disease (ankle-brachial index 78%, toe-brachial index 63%). Both modalities had good overall specificity (ankle-brachial index 96%, toe-brachial index 86%). In patients with diabetes, the ankle-brachial index specificity was 94% and toe-brachial index specificity was 79%. Both physiologic modalities had identical accuracy (0.43) in comparison to duplex ultrasound. Routine toe-brachial index in conjunction with the ankle-brachial index may not be clinically productive.
{"title":"Utility of Toe-Brachial Index","authors":"William Del Valle","doi":"10.1177/15443167241249246","DOIUrl":"https://doi.org/10.1177/15443167241249246","url":null,"abstract":"The toe-brachial index is typically an adjunctive examination to the ankle-brachial index, which has long been the primary physiologic modality for diagnosing peripheral arterial disease. The goal of this project was to determine toe-brachial index reliability, particularly with patients with diabetes. We compared duplex ultrasound to the ankle-brachial index and toe-brachial index on 100 patients (200 legs) with suspected symptomatic peripheral arterial disease. Duplex ultrasound stenosis in the femoral/popliteal/infrapopliteal arteries was at least a doubling of velocity between adjacent segments. A blunted systolic Doppler waveform was consistent with proximal occlusive disease. Normal physiologic ranges were arbitrarily set as ankle-brachial index 1.2 to 0.9 and toe-brachial index 0.9 to 0.5. We calculated overall sensitivity/specificity values by averaging. Both physiologic modalities had overall low sensitivity (ankle-brachial index 62%, toe-brachial index 56%). In diabetics, ankle-brachial index sensitivity was 61% and toe-brachial index sensitivity was 57%. Sensitivity improved in the presence of inflow disease (ankle-brachial index 78%, toe-brachial index 63%). Both modalities had good overall specificity (ankle-brachial index 96%, toe-brachial index 86%). In patients with diabetes, the ankle-brachial index specificity was 94% and toe-brachial index specificity was 79%. Both physiologic modalities had identical accuracy (0.43) in comparison to duplex ultrasound. Routine toe-brachial index in conjunction with the ankle-brachial index may not be clinically productive.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":" 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140992311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-08DOI: 10.1177/15443167241249241
E. Wooster, David M. Williams, D. Wooster
In 2021, the Intersocietal Accreditation Commission (IAC) introduced modified criteria for carotid duplex interpretation based on peak systolic velocity (PSV) and PSV ratio. The most significant change compared to the 2003 Society of Radiologists in Ultrasound (SRU) criteria involved re-defining the thresholds for <50 and 50% to 69% stenosis ranges. Patients identified in <50% vs 50% to 69% ranges may face different disease severity assignments, variable surveillance protocols, medical management approaches, and recommendations for intervention. Facilities may experience altered payment coverage, issues of staff re-training, and questions from referring physicians regarding patient treatment and disease management expectations. The objective of this study was to assess the impact of re-defining these stenosis ranges using the 2021 IAC criteria vs the SRU criteria. Anonymized patient data from carotid duplex examinations were collected as part of an internal laboratory quality improvement strategy. These data were analyzed in an electronic database using the IAC and SRU threshold criteria to determine the degree of carotid stenosis. Patients with normal arteries, unilateral studies, or complete occlusions were excluded. Of the 1000 patients considered, 850 met the eligibility criteria. Using PSV: for the right carotid, 242 (28.5%) showed a change and 608 (71.5%) showed no change in stenosis classification; for the left carotid, 228 (27%) showed a change and 622 (73%) showed no change. All changes were a downgrading of disease to <50% stenosis. Using PSV ratio: for the right carotid, re-assignment of 53 (22% of changed, 6% of total cohort); for the left carotid, re-assignment of 48 (21% of changed, 5.6% of total cohort). All changes resulted in re-assignment to the 50% to 69% stenosis category. Implementation of the IAC criteria resulted in patients being re-assigned to lower stenosis categories (27% for PSV and 21% for PSV ratio). The impact of these changes on patient care and facility logistics needs careful consideration.
{"title":"Carotid Disease Classification: Impact of the 2021 Intersocietal Accreditation Commission Updated Recommendations vs 2003 Society of Radiologists in Ultrasound Consensus Conference Criteria","authors":"E. Wooster, David M. Williams, D. Wooster","doi":"10.1177/15443167241249241","DOIUrl":"https://doi.org/10.1177/15443167241249241","url":null,"abstract":"In 2021, the Intersocietal Accreditation Commission (IAC) introduced modified criteria for carotid duplex interpretation based on peak systolic velocity (PSV) and PSV ratio. The most significant change compared to the 2003 Society of Radiologists in Ultrasound (SRU) criteria involved re-defining the thresholds for <50 and 50% to 69% stenosis ranges. Patients identified in <50% vs 50% to 69% ranges may face different disease severity assignments, variable surveillance protocols, medical management approaches, and recommendations for intervention. Facilities may experience altered payment coverage, issues of staff re-training, and questions from referring physicians regarding patient treatment and disease management expectations. The objective of this study was to assess the impact of re-defining these stenosis ranges using the 2021 IAC criteria vs the SRU criteria. Anonymized patient data from carotid duplex examinations were collected as part of an internal laboratory quality improvement strategy. These data were analyzed in an electronic database using the IAC and SRU threshold criteria to determine the degree of carotid stenosis. Patients with normal arteries, unilateral studies, or complete occlusions were excluded. Of the 1000 patients considered, 850 met the eligibility criteria. Using PSV: for the right carotid, 242 (28.5%) showed a change and 608 (71.5%) showed no change in stenosis classification; for the left carotid, 228 (27%) showed a change and 622 (73%) showed no change. All changes were a downgrading of disease to <50% stenosis. Using PSV ratio: for the right carotid, re-assignment of 53 (22% of changed, 6% of total cohort); for the left carotid, re-assignment of 48 (21% of changed, 5.6% of total cohort). All changes resulted in re-assignment to the 50% to 69% stenosis category. Implementation of the IAC criteria resulted in patients being re-assigned to lower stenosis categories (27% for PSV and 21% for PSV ratio). The impact of these changes on patient care and facility logistics needs careful consideration.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":" 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1177/15443167241226786
{"title":"Utilization of Deep Vein Arterialization for Limb Salvage for CME Credit March 2024","authors":"","doi":"10.1177/15443167241226786","DOIUrl":"https://doi.org/10.1177/15443167241226786","url":null,"abstract":"","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"110 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1177/15443167241226785
{"title":"Contribution of Doppler Ultrasound of the Supra-Aortic Trunks in the Etiological Evaluation of Ischemic Strokes at the Douala General Hospital for CME Credit March 2024","authors":"","doi":"10.1177/15443167241226785","DOIUrl":"https://doi.org/10.1177/15443167241226785","url":null,"abstract":"","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"30 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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