Pub Date : 2023-02-15DOI: 10.1177/15443167221149706
Sophia Cuschieri, Priyanka D. Rao, Amy Lara, Jill Sommerset, R. Karmy-Jones
Introduction: The global burden of peripheral arterial disease and related critical limb ischemia has been increasing, and with it an increased incidence of limb loss and mortality. Multidisciplinary teams appear to have a beneficial impact on managing these complex patients, but measuring success depends on the outcome chosen. Determining the risk/benefit of intervention can be difficult, and there has been increasing emphasis on using frailty measures to predict the likelihood of morbidity and mortality after vascular interventions. Methods: We performed a retrospective review of patients referred to a multidisciplinary team over a 5-year period who underwent intervention. Data included the modified Frailty Index (mFI), Society for Vascular Surgery (SVS) WIfI wound score (0-2 vs 3), and pedal acceleration time (PAT) post-procedure. Outcomes analyzed were 1-year amputation-free survival (AFS-1), independence, and major complications. Results: There were 81 patients who underwent either open or endovascular revascularization. One-year amputation-free survival was positively correlated with post-procedure PAT (AFS-1 107.3 ± 25.5 vs non-AFS-1 174 ± 93; P = .025) and inversely related to wound score (SVS 3 AFS-1 5/17 [29%] vs SVS 0-2: 46/64 [72%]; P = .025). Independence was linked to wheelchair dependence prior to intervention with 6/16 (38%) patients patients spending more than 50% of their time in a wheelchair being independent versus 56/64 (88%) who were not wheelchair-dependent being independent (P = .005). An mFI ≥6 was associated with increased incidence of major complications at 1 year (mFI ≥6 11/31 [35%] vs mFI <6 5/50 [10%]; P = .018). Conclusion: One-year amputation-free survival was impacted by post-procedural success as measured by PAT, but negatively impacted by severity of wound at presentation. An mFI ≥6 was associated with greater incidence of complications. These findings may impact decision-making in determining the relative risk/benefit of revascularization in CLI. Vascular technologists can have an important role in development of limb salvage teams.
{"title":"Factors Predicting Outcome in Patients With Critical Limb Ischemia After Multidisciplinary Team Treatment: A 5-Year Single-Center Retrospective Review","authors":"Sophia Cuschieri, Priyanka D. Rao, Amy Lara, Jill Sommerset, R. Karmy-Jones","doi":"10.1177/15443167221149706","DOIUrl":"https://doi.org/10.1177/15443167221149706","url":null,"abstract":"Introduction: The global burden of peripheral arterial disease and related critical limb ischemia has been increasing, and with it an increased incidence of limb loss and mortality. Multidisciplinary teams appear to have a beneficial impact on managing these complex patients, but measuring success depends on the outcome chosen. Determining the risk/benefit of intervention can be difficult, and there has been increasing emphasis on using frailty measures to predict the likelihood of morbidity and mortality after vascular interventions. Methods: We performed a retrospective review of patients referred to a multidisciplinary team over a 5-year period who underwent intervention. Data included the modified Frailty Index (mFI), Society for Vascular Surgery (SVS) WIfI wound score (0-2 vs 3), and pedal acceleration time (PAT) post-procedure. Outcomes analyzed were 1-year amputation-free survival (AFS-1), independence, and major complications. Results: There were 81 patients who underwent either open or endovascular revascularization. One-year amputation-free survival was positively correlated with post-procedure PAT (AFS-1 107.3 ± 25.5 vs non-AFS-1 174 ± 93; P = .025) and inversely related to wound score (SVS 3 AFS-1 5/17 [29%] vs SVS 0-2: 46/64 [72%]; P = .025). Independence was linked to wheelchair dependence prior to intervention with 6/16 (38%) patients patients spending more than 50% of their time in a wheelchair being independent versus 56/64 (88%) who were not wheelchair-dependent being independent (P = .005). An mFI ≥6 was associated with increased incidence of major complications at 1 year (mFI ≥6 11/31 [35%] vs mFI <6 5/50 [10%]; P = .018). Conclusion: One-year amputation-free survival was impacted by post-procedural success as measured by PAT, but negatively impacted by severity of wound at presentation. An mFI ≥6 was associated with greater incidence of complications. These findings may impact decision-making in determining the relative risk/benefit of revascularization in CLI. Vascular technologists can have an important role in development of limb salvage teams.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"47 1","pages":"86 - 92"},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44201520","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}
Introduction: The gradual process of atherosclerosis involves both structural and functional changes that can accumulate over years and contribute to cardiovascular risk. We propose the use of color M-mode ultrasound to evaluate the distensibility of the carotid artery as a quantitative measurement of dynamic function that could evaluate age-related vascular change when considering atherosclerotic cardiovascular disease evaluation and risk. The aim of the study was to assess the feasibility of color M-mode ultrasound to evaluate age-related changes in the carotid arteries. Methods: Color M-mode ultrasound of the distal common carotid artery (CCA) with concurrent electrocardiogram tracing was performed on 62 adults (19 men and 43 women) in 3 age groups: young adult (20-44 years; n = 22), middle age (45-64 years; n = 20), and senior (≥65 years; n = 20). Color M-mode ultrasound images of the CCA were processed offline using ImageJ to quantify total, red, green, and blue (RGB) pixels in systole and diastole. The CCA distensibility was calculated by using the following equation: distensibility coefficient (DC) = (systolic − diastolic diameter)/(diastolic diameter × pulse pressure). The difference in ultrasound parameters among the 3 age groups was analyzed by one-way analysis of variance (ANOVA). Intraobserver and interobserver reliability of offline imaging processing was tested using intraclass correlation coefficient (ICC). Results: We observed a significant difference in CCA distensibility among the 3 age groups (P < .05). The interobserver reproducibility and intraobserver repeatability in performing offline image processing were excellent (ICC >0.85). Conclusion: These findings suggest that color M-mode ultrasound is feasible in evaluating changes in CCA distensibility and systolic pixel values representing CCA blood flow significantly decreased in seniors.
{"title":"Color M-Mode Ultrasound to Assess Carotid Arteries: A Feasibility Study","authors":"Jessica Carlson, Tyler Adams, Juhyun Lee, Jing Gao","doi":"10.1177/15443167221150962","DOIUrl":"https://doi.org/10.1177/15443167221150962","url":null,"abstract":"Introduction: The gradual process of atherosclerosis involves both structural and functional changes that can accumulate over years and contribute to cardiovascular risk. We propose the use of color M-mode ultrasound to evaluate the distensibility of the carotid artery as a quantitative measurement of dynamic function that could evaluate age-related vascular change when considering atherosclerotic cardiovascular disease evaluation and risk. The aim of the study was to assess the feasibility of color M-mode ultrasound to evaluate age-related changes in the carotid arteries. Methods: Color M-mode ultrasound of the distal common carotid artery (CCA) with concurrent electrocardiogram tracing was performed on 62 adults (19 men and 43 women) in 3 age groups: young adult (20-44 years; n = 22), middle age (45-64 years; n = 20), and senior (≥65 years; n = 20). Color M-mode ultrasound images of the CCA were processed offline using ImageJ to quantify total, red, green, and blue (RGB) pixels in systole and diastole. The CCA distensibility was calculated by using the following equation: distensibility coefficient (DC) = (systolic − diastolic diameter)/(diastolic diameter × pulse pressure). The difference in ultrasound parameters among the 3 age groups was analyzed by one-way analysis of variance (ANOVA). Intraobserver and interobserver reliability of offline imaging processing was tested using intraclass correlation coefficient (ICC). Results: We observed a significant difference in CCA distensibility among the 3 age groups (P < .05). The interobserver reproducibility and intraobserver repeatability in performing offline image processing were excellent (ICC >0.85). Conclusion: These findings suggest that color M-mode ultrasound is feasible in evaluating changes in CCA distensibility and systolic pixel values representing CCA blood flow significantly decreased in seniors.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"47 1","pages":"125 - 131"},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45380807","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 : 2023-02-07DOI: 10.1177/15443167221149756
Silfayner Victor Mathias Dias, R. Flumignan, Wagner Iared, Letícia Silva Teixeira, Rafael Albanês Pires, M. J. de Almeida, Ludvig Hafner
Persistence of the sciatic vein is a venous anomaly located in the lower limbs. Accounts in the literature rarely include patients who do not have the Klippel-Trenaunay-Weber syndrome. We present a case of a woman with bilateral persistent sciatic veins and no Klippel-Trenaunay-Weber syndrome, first suspected on a duplex ultrasound examination and then confirmed by computed tomography angiography. Persistent sciatic vein is a rare venous anomaly. Although the prevalence of persistent sciatic veins is possibly underestimated, we should be aware of its presence, considering its relevance in contributing to venous disease.
{"title":"Persistent Sciatic Veins","authors":"Silfayner Victor Mathias Dias, R. Flumignan, Wagner Iared, Letícia Silva Teixeira, Rafael Albanês Pires, M. J. de Almeida, Ludvig Hafner","doi":"10.1177/15443167221149756","DOIUrl":"https://doi.org/10.1177/15443167221149756","url":null,"abstract":"Persistence of the sciatic vein is a venous anomaly located in the lower limbs. Accounts in the literature rarely include patients who do not have the Klippel-Trenaunay-Weber syndrome. We present a case of a woman with bilateral persistent sciatic veins and no Klippel-Trenaunay-Weber syndrome, first suspected on a duplex ultrasound examination and then confirmed by computed tomography angiography. Persistent sciatic vein is a rare venous anomaly. Although the prevalence of persistent sciatic veins is possibly underestimated, we should be aware of its presence, considering its relevance in contributing to venous disease.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"47 1","pages":"97 - 101"},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41367708","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 : 2023-01-11DOI: 10.1177/15443167221147521
Cassey Noh
This case report illustrates the most unique feature of ultrasound that distinguishes it from other imaging modalities: hemodynamic analysis of blood flow by spectral Doppler waveforms. Duplex evaluation of the patient presented showed the different resulting hemodynamic impacts of the Amplatzer Vascular Plug II (AVP II), an embolic device, as a foreign body in the upper extremity versus the lower extremity: monophasic Doppler waveforms in the upper extremity distal to the location of the AVP II versus multiphasic Doppler waveforms in the comparable lower extremity distal location. This hemodynamic analysis illustrates the different impacts of the migrated AVP II as a foreign body. It is possible that paroxysmal atrial fibrillation could have been a cause of AVP II migration in this case, since there was no surgical manipulation following placement, but that would be a topic for further investigation.
{"title":"Duplex Studies of Amplatzer Vascular Plug II as a Foreign Body: Detection and Localization Following Migration From the Heart to the Extremities","authors":"Cassey Noh","doi":"10.1177/15443167221147521","DOIUrl":"https://doi.org/10.1177/15443167221147521","url":null,"abstract":"This case report illustrates the most unique feature of ultrasound that distinguishes it from other imaging modalities: hemodynamic analysis of blood flow by spectral Doppler waveforms. Duplex evaluation of the patient presented showed the different resulting hemodynamic impacts of the Amplatzer Vascular Plug II (AVP II), an embolic device, as a foreign body in the upper extremity versus the lower extremity: monophasic Doppler waveforms in the upper extremity distal to the location of the AVP II versus multiphasic Doppler waveforms in the comparable lower extremity distal location. This hemodynamic analysis illustrates the different impacts of the migrated AVP II as a foreign body. It is possible that paroxysmal atrial fibrillation could have been a cause of AVP II migration in this case, since there was no surgical manipulation following placement, but that would be a topic for further investigation.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136211782","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 : 2022-12-29DOI: 10.1177/15443167221141954
R. E. Zierler
It is rewarding to see readers and authors engaged in constructive dialogue around articles published in the Journal for Vascular Ultrasound. Interpretation of Doppler waveforms is a topic that always seems to generate considerable interest and discussion. The 2020 Consensus Statement from the Society for Vascular Medicine and Society for Vascular Ultrasound on “Interpretation of Peripheral Arterial and Venous Doppler Waveforms” helped to standardize the nomenclature for Doppler waveforms and provided examples of normal and abnormal flow patterns. The Doppler waveform features associated with arterial steal physiology can be particularly complex and variable, as shown by the case report referred to in these letters. As a final comment, the use of an electrocardiogram (ECG) along with Doppler waveforms is rarely necessary in routine noncardiac vascular ultrasound. However, there are situations when the systolic and diastolic phases of the Doppler waveform are difficult to identify clearly, and a simultaneous ECG is helpful to show the relationship between the segments of the Doppler waveform and the systolic and diastolic components of the cardiac cycle.
{"title":"Editor’s Comment","authors":"R. E. Zierler","doi":"10.1177/15443167221141954","DOIUrl":"https://doi.org/10.1177/15443167221141954","url":null,"abstract":"It is rewarding to see readers and authors engaged in constructive dialogue around articles published in the Journal for Vascular Ultrasound. Interpretation of Doppler waveforms is a topic that always seems to generate considerable interest and discussion. The 2020 Consensus Statement from the Society for Vascular Medicine and Society for Vascular Ultrasound on “Interpretation of Peripheral Arterial and Venous Doppler Waveforms” helped to standardize the nomenclature for Doppler waveforms and provided examples of normal and abnormal flow patterns. The Doppler waveform features associated with arterial steal physiology can be particularly complex and variable, as shown by the case report referred to in these letters. As a final comment, the use of an electrocardiogram (ECG) along with Doppler waveforms is rarely necessary in routine noncardiac vascular ultrasound. However, there are situations when the systolic and diastolic phases of the Doppler waveform are difficult to identify clearly, and a simultaneous ECG is helpful to show the relationship between the segments of the Doppler waveform and the systolic and diastolic components of the cardiac cycle.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"47 1","pages":"15 - 15"},"PeriodicalIF":0.0,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47362208","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 : 2022-12-15DOI: 10.1177/15443167221141194
J. Rodriguez
{"title":"Doppler Study of the Left Common Carotid Artery With Preocclusive Stenosis","authors":"J. Rodriguez","doi":"10.1177/15443167221141194","DOIUrl":"https://doi.org/10.1177/15443167221141194","url":null,"abstract":"","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"47 1","pages":"10 - 11"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48964943","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 : 2022-12-01DOI: 10.1177/15443167221130646
{"title":"A Vascular Surgery–Specific Ultrasound Model for Vascular Access for CME credit December 2022","authors":"","doi":"10.1177/15443167221130646","DOIUrl":"https://doi.org/10.1177/15443167221130646","url":null,"abstract":"","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"46 1","pages":"183 - 183"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45503077","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 : 2022-12-01DOI: 10.1177/15443167221130641
{"title":"Patterns of Infra-Popliteal Arterial Disease for CME credit December 2022","authors":"","doi":"10.1177/15443167221130641","DOIUrl":"https://doi.org/10.1177/15443167221130641","url":null,"abstract":"","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"46 1","pages":"179 - 179"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510825","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 : 2022-12-01DOI: 10.1177/15443167221095175
William Del Valle, David Wedderman
Introduction The growth of the diabetic population and the increased prevalence of peripheral arterial disease (PAD) below the knee has created an increased demand for duplex ultrasound (DUS) evaluation of the infra-popliteal arteries. The purpose of this study is to show how DUS can be used to identify the patterns of infra-popliteal arterial occlusive disease. Methods: We performed infra-popliteal duplex ultrasound scans on 100 consecutive patients (199 limbs) with suspected PAD. Peak systolic velocity (PSV) was obtained from the anterior tibial artery (ATA) and posterior tibial artery (PTA) at the distal, mid, and proximal calf levels. The acceleration time (AT) was measured in the distal ATA and PTA segments. Results: The PTA was the infra-popliteal artery that was most often totally occluded (21% of limbs). Segmental PTA occlusions occurred predominantly in the proximal and distal segments. The ATA was totally occluded in 8% of limbs, with segmental occlusions located predominantly in the mid segment. We also confirmed that proximal PAD prolongs distal infra-popliteal artery AT and reduces distal PSV. Conclusion: These data add to our understanding of the patterns of infra-popliteal arterial disease and should be of interest to sonographers who perform DUS of the lower extremity arteries.
{"title":"Patterns of Infra-Popliteal Arterial Disease","authors":"William Del Valle, David Wedderman","doi":"10.1177/15443167221095175","DOIUrl":"https://doi.org/10.1177/15443167221095175","url":null,"abstract":"Introduction The growth of the diabetic population and the increased prevalence of peripheral arterial disease (PAD) below the knee has created an increased demand for duplex ultrasound (DUS) evaluation of the infra-popliteal arteries. The purpose of this study is to show how DUS can be used to identify the patterns of infra-popliteal arterial occlusive disease. Methods: We performed infra-popliteal duplex ultrasound scans on 100 consecutive patients (199 limbs) with suspected PAD. Peak systolic velocity (PSV) was obtained from the anterior tibial artery (ATA) and posterior tibial artery (PTA) at the distal, mid, and proximal calf levels. The acceleration time (AT) was measured in the distal ATA and PTA segments. Results: The PTA was the infra-popliteal artery that was most often totally occluded (21% of limbs). Segmental PTA occlusions occurred predominantly in the proximal and distal segments. The ATA was totally occluded in 8% of limbs, with segmental occlusions located predominantly in the mid segment. We also confirmed that proximal PAD prolongs distal infra-popliteal artery AT and reduces distal PSV. Conclusion: These data add to our understanding of the patterns of infra-popliteal arterial disease and should be of interest to sonographers who perform DUS of the lower extremity arteries.","PeriodicalId":52510,"journal":{"name":"Journal for Vascular Ultrasound","volume":"46 1","pages":"156 - 159"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44788194","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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