دانلود کتاب Noninvasive Vascular Diagnosis: A Practical Textbook for Clinicians

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Foreword
Preface to the Fifth Edition
Preface to the Fourth Edition
Acknowledgments
Contents
About the Editors
About the Section Editors
Contributors
Part I: Vascular Laboratory Operations
1 Improving Quality in Noninvasive Testing by Certification and Accreditation
Introduction
Definitions
Technologist Credentialing
Physician Credentialing
Content Outline for the PVI examination
Accreditation
Background
Accreditation Statistics
Accreditation, Credentialing, and Quality
Future Considerations
Review Questions
Answer Key
References
2 Physician Qualifications in the Clinical Diagnostic Vascular Laboratory
Introduction
Vascular Laboratory Accreditation
Educational Background
Physician Qualifications
Credentialing
Review Questions
Answer Key
References
3 Quality in the Vascular Laboratory
Introduction
What Is Quality?
Quality Programs
General Components of a CQI Program
Appropriate Metrics for Analysis
Accuracy and Clinical Utility/Efficacy and Effectiveness in the Vascular Lab
The Role of Accreditation
A New Approach to Continuous Quality Improvement (CQI)
Case Review Metrics
Appropriateness of Use
Technical Quality Review
Interpretive Quality Review
Final Report Completeness and Timeliness Review
Case Review and Correlation
CQI Policies, Procedures, and Minutes
Implementation
Limitations of Accreditation
The Future
Review Questions
Answer Key
Cross-References
References
4 Ergonomics and the Vascular Lab
Introduction
Injuries in Sonography
Understanding WRMSD in Sonography
Awkward Postures
Excess Force
Repetition
Static Postures
Prolonged Exposure
Risk Reduction
Engineering Controls
The Importance of Equipment Adjustability
Work Areas
Ancillary Equipment Options
Administrative Controls
Risk Assessment
Protocols
Scheduling
Sonographer Control Measures
Neutral Posture
Postural Influence on Sonographer Injury
Education and Training
The Future of Sonography
Review Questions
Answer Key
References
Part II: Vascular Hemodynamics and Basic Vascular Physics
5 Principles of Vascular Ultrasound Physics
Introduction
Ultrasound Imaging General Principles
Image Generation
Ultrasound Transducers
Sequential Image Generation
Absorption
Reflection
Depth and Speed of Sound
Spatial Resolution
Contrast Resolution
Video Compression
Ultrasound Imaging Advanced Principles
Harmonic Imaging
Compound Imaging
Parallel Processing and Image Generation
Diverging/Plane Wave and Ultrafast Image Generation
Image Optimization
2D Image Optimization
IMT Measurement Optimization
Spectral Doppler Basics
Understanding Angle Correction
Why Does Doppler Angle Matter?
Standardized Doppler Measurements
Correct Operating Frequency
Color Doppler
Sequential Color Image Generation
Parallel Processing and Color Image Generation
Ultrafast Image Generation
Color Priority and Color Gain
Correct Operating Frequency
Color Scales and Wall Filters
Color Power (Angio) Doppler
Slow Flow (Microvascular) Detection
Conclusion
Review Questions
Answer Key
Cross-References
References
6 Vascular Hemodynamics
Introduction
Blood Flow in the Normal Arterial Circulation
Blood Flow in Diseased Arteries
Critical Stenosis
Peak Velocity
Turbulence
Changes in Velocity Profile
Autoregulation
Vascular ``Steal´´ Phenomena
Blood Flow in the Normal Venous Circulation
Blood Flow in Diseased Veins
Review Questions
Answer Key
Part III: Noninvasive Diagnosis of Cerebrovascular Disease
7 Overview of Cerebrovascular Disease
Introduction/Epidemiology of Extracranial Cerebrovascular Disease
Anatomy
Cerebral Collateral Pathways
Morphologic Variations of the Internal Carotid Artery
Pathology
Pathophysiology
Clinical Presentation/Syndromes
Physical Examination
Investigations/Clinical Assessment
Overview of Various Noninvasive Cerebrovascular Techniques
Historical Perspectives
Carotid Duplex Scanning
Transcranial Doppler
Carotid CTA/MRA/Conventional Arteriography
Conventional Carotid Arteriography
Society for Vascular Surgery (SVS) Guideline Recommendations for the Use of Carotid Bifurcation Imaging and Selection of Carot...
Interpretation of Stenosis
Percentage of Stenosis Calculation: Diameter Reduction
Percentage of Stenosis Calculation: Area Reduction
Treatment
SVS Recommendations for Selecting Therapy for Cerebrovascular Disease [70, 71]
Review Questions
Answer Key
References
8 Color Duplex Scanning of the Extracranial Carotid Arteries
Introduction/Duplex Ultrasound Components
Real-Time B-Mode Imaging
Doppler Spectral Waveform Analysis
Duplex Instrumentation
Carotid Duplex Examination Protocol
Limitations of Duplex Technology
Interpretation and Determination of Severity of Carotid Stenosis
B-Mode Imaging Interpretation
Estimation of Stenosis Based on B-Mode Imaging
Interpretation of Doppler Spectral Analysis
Normal Findings
Abnormal Findings
Determination of Disease Severity Using Doppler Spectral Analysis/Velocities
University of Washington Carotid Duplex Criteria (Strandness)
Normal Internal Carotid Spectra or Minimal Disease (0-15% Stenosis)
Mild Stenosis (16-<50%)
Moderate to Severe Disease (50-<80% Stenosis)
Tight Stenosis (80-99%)
Near Occlusion/Internal Carotid Occlusion
The Role of Power Doppler and Carotid Artery Occlusion
External Carotid Artery Disease (High-Grade Stenosis)
Zwiebel Carotid Duplex Criteria
Duplex Classification for Threshold Stenoses Used in Various Symptomatic and Asymptomatic Carotid Endarterectomy Trials [13]
Carotid Duplex Consensus Criteria for Grading Carotid Artery Stenosis
Accuracy of Duplex Scanning in the Detection of Carotid Stenosis and Severity
CTA-Derived Duplex Ultrasound Velocity Criteria of Carotid Stenosis
Effect of Contralateral Stenosis or Occlusion on Ipsilateral Carotid Stenosis Duplex Criteria
Changes in Carotid Duplex Ultrasound Velocities After Aortic Valve Replacement for Severe Aortic Stenosis
Clinical Use of Carotid Duplex Scanning
Review Questions
Answer Key
Cross-References
References
9 Ultrasonic Characterization of Carotid Plaques and Its Clinical Implications
Introduction
The Need for Image Normalization
Development of Image Normalization
Current Guidelines for Maximization of Reproducibility of GSM
Image Acquisition
Technique of Image Normalization and Measurement of GSM Using Adobe Photoshop
Dedicated Software
Type 1
Type 2
Type 3
Types 4 and 5
Comparison of GSM Obtained Using Adobe Photoshop with GSM Obtained Using the Plaque Texture Analysis Software
Effect of Image Normalization on Plaque Classification
Pixel Distribution Analysis (PDA)
Prospective Studies
The ACSRS Study
The Value of Plaque Features After Image Normalization
Definitions and Reproducibility of Texture Features in the ACSRS
Gray-Scale Median (GSM)
Plaque Type
Plaque Area
Discrete White Areas (DWA)
Juxtaluminal Black Area Without a Visible Echogenic Cap (JBA)
Ability of Individual Features to Identify High-Risk Groups
Stenosis
Gray-Scale Median
Plaque Type and Risk
Plaque Area
Discrete White Areas
Juxtaluminal Black Area Without a Visible Echogenic Cup
The Value of Clinical Features
Combination of Features and Calculation of Stroke Risk in Individual Patients
Semiautomated Method of Image Analysis and Stroke Risk Prediction
Validation of Ultrasonic Texture Features Used in the ACSRS Study by Recent Histological Studies
General Remarks and Conclusions
Review Questions
Answer Key
References
10 Role of Duplex Ultrasound in Carotid Screening
Introduction
Epidemiology of Stroke
Epidemiology of Carotid Artery Disease
Pathophysiology of Carotid Artery Atherosclerosis and its Relationship to Stroke
Natural History of Extracranial Carotid Artery Atherosclerosis
Rationale for Screening for Carotid Artery Disease
Duplex Ultrasound
Screening in the General Population
Screening in Asymptomatic High-Risk Groups
Selected Asymptomatic Populations with a High Prevalence of Carotid Disease in which Screening Might be Considered
Patients with Peripheral Arterial Disease
Patients Undergoing Coronary Artery Bypass Surgery
Asymptomatic Patients with an Audible Carotid Bruit
Asymptomatic Patients with Prior Neck Irradiation
Patients with Abdominal Aortic Aneurysm (AAA)
Patients with Clinically Occult Cerebral Infarction or High-Risk Factors on Brain Imaging
Summary and Conclusions
Conclusions
Review Questions
Answer Key
Cross-References
References
11 Duplex Ultrasound Velocity Criteria in Carotid Artery Stenting Patients
Introduction
Incidence
Carotid Endarterectomy
Carotid Artery Stenting
Natural History
Carotid Endarterectomy
Carotid Artery Stenting
Dus Velocity Criteria
Carotid Endarterectomy
Carotid Artery Stenting
Surveillance Frequency
Carotid Endarterectomy
Carotid Artery Stenting
Dus Testing Protocol After CAS
Review Questions
Answer Key
References
12 Intraoperative Ultrasound Assessment of Carotid Endarterectomy and Carotid Stent Angioplasty
Introduction
Carotid Endarterectomy Duplex Scanning Protocol and Interpretation
Carotid Stent-Angioplasty IVUS Scanning Protocol and Test Interpretation
Summary
Review Questions
Answer Key
References
13 Intima-Media Thickness and Plaque Evaluation: Predictive Value of Cardiovascular Events and Contribution to Cardiovascular ...
Introduction
Definition
How to Validate a New Biomarker
IMT and Atherosclerosis: A Subclinical Disease
Normal cIMT Values
Predictive Value on Cardiovascular Events and Cardiovascular Risk Evaluation
IMT, Cardiovascular Risk Assessment and Atherosclerosis Risk Factors
ACC/AHA Recommendations Provided in 2010 Guidelines for Cardiovascular Risk Assessment
CIMT in Clinical Trials
Conclusion
Review Questions
Answer Key
References
14 Color Duplex Scanning of the Brachiocephalic/Subclavian Arteries
Introduction
Anatomy of the Aortic Arch and Brachiocephalic Veins
Aortic Arch
Brachiocephalic Veins
Imaging the Aortic Arch and Brachiocephalic Veins
Brachiocephalic Veins
Using Color Flow to Assess the Central Vessels
Clinical Role of Color Duplex Ultrasound in Diagnosing Arch Vessels
Ostial and Proximal Common Carotid Artery Lesions
Occluded Common Carotid Artery
Ostial Left Subclavian Artery Stenosis and Occlusion
Innominate Artery Stenosis or Occlusion
Type A Dissection of the Aorta Involving the Ostium of the Arch Vessels
Conclusions
Review Questions
Answer Key
References
15 Color Duplex Scanning of Vertebral Artery
Introduction
Anatomy of the Vertebrobasilar Arterial System
Duplex Ultrasound Examination Technique and Scanning Protocol
Imaging of the Vertebral Artery
Color Flow Ultrasound Evaluation of Flow Dynamics
Doppler Spectral Evaluation of Flow Dynamics
Extracranial Duplex Examination Should Provide the Following Data
Tips to Improve Accuracy
Clinical Indications and Diagnostic Criteria of Duplex Scanning of the Extracranial VA
Atherosclerotic Disease
Arterial Dissection
Subclavian Steal
Indications to Expand the Extracranial Exam to TCD or TCCD
Review Questions
Answer Key
Cross-References
References
16 Transcranial Doppler Sonography
The Principles of Transcranial Doppler
Power Motion (M-Mode) Doppler
Transcranial Color-Coded Duplex
Examination Techniques
Transtemporal Insonation Steps (Applicable to TCD and TCCD)
Transorbital Insonation Steps (Applicable to TCD)
Transforaminal Insonation Steps (Applicable to TCD and TCCD)
Submandibular Insonation Steps (Applicable to TCD)
Criteria for Normal TCD/TCCD Findings
Cerebrovascular Resistance and Hemodynamic Indices
Clinical Indications and Diagnostic Criteria
Sickle Cell Disease
Cerebral Vasospasm
Acute Cerebral Ischemia
Middle Cerebral Artery Stenosis
Anterior Cerebral Artery Stenosis
Terminal Internal Carotid Artery and Siphon Stenosis
Posterior Cerebral Artery Stenosis
Basilar Artery Stenosis
Intracranial Vertebral Artery Stenosis
Arterial Occlusion
Middle Cerebral Artery Occlusion
Intracranial Internal Carotid Artery Occlusion
Basilar Artery Occlusion
Intracranial Vertebral Artery Occlusion
Cerebral Hyperperfusion
Intracranial Collateral Pathways
Reversed Flow in the Ophthalmic Artery
Anterior Communicating Artery and Anterior Cross-Filling
Posterior Communicating Artery
Reversed Flow in the Basilar Artery
Vasomotor Reactivity Testing
Cerebral Embolization
Detection of Cardiac Right-to-Left Shunt
Increased Intracranial Pressure
Cerebral Circulatory Arrest
Subclavian Steal
Reversed Robin Hood Syndrome
Summary
Review Questions
Answer Key
Cross-References
References
17 TCD Monitoring During Carotid Artery Stenting
Introduction
Background
Transcranial Doppler: Periprocedural Setup
Pre-Procedural ``Baseline´´ TCD Observations
Periprocedural TCD Observations
Post-procedural TCD Observations
Significance of Microemboli During Carotid Artery Stenting
Differentiating Microemboli from Air Bubbles
Conclusions
Review Questions
Answer Key
Cross-References
References
18 Errors and Artifacts of Carotid Ultrasound Evaluation
Introduction
Variability of Measurements by Technologists and between Technologists
Variability of Diagnostic Velocity Criteria
Clinical Situations Affecting PSV Measurements
Contralateral Stenosis or Occlusion
Error After Previous Endarterectomy, Patch, or Stent
Near Occlusion Versus Complete Occlusion
Gender
Cardiac Output
Failure to Define Percentage Severity of Stenosis
Angle of Insonation Incorrect
Technologist Incorrectly Aligns Cursor
Error from Different Angles 45-60
Actual Flow Vector Is Not Parallel to Walls
Beam and Sample Volume Positioned Close to the Ends of the Transducer
Sample Volume Is Positioned Incorrectly
Peak Velocity Not at Stenosis
Confusing ICA and ECA
Anatomical Location
Branches
Temporal Artery Tap
Spectral Doppler Waveforms
Congenital Abnormalities
Patient Factors
Ultrasound Artifacts
Vessel Calcification and Acoustic Shadowing
Mirror Image Artifacts
Refraction
Errors Due to Automated Measurement
Failure to Obtain Two Views of Stenosis
Other Diseases that May be Confused with Atherosclerosis
Dissection
Fibromuscular Dysplasia
Takayasu´s Disease
Conclusion
Review Questions
Answer Key
References
19 Computed Tomography Angiography and Magnetic Resonance Angiography of the Carotids
Introduction
Selecting Imaging Modalities for Carotid Evaluation
Carotid Duplex Ultrasound (CDUS)
Computed Tomographic Angiography (CTA)
Magnetic Resonance Imaging (MRA/MRI)
Catheter-Based Digital Subtraction Arteriography (DSA)
Comparison of CDUS/MRA/CTA/DSA
Recommendations for Selection of Carotid Imaging Modalities
Other Indications for Alternate Carotid Imaging
Internal Carotid Pseudo-Occlusion
Unstable Carotid Plaque
Carotid Bifurcation Thrombus
Vertebrobasilar Insufficiency
Recurrent Carotid Stenosis
Intracranial Pathology
Fibromuscular Dysplasia and Associated Arteridities
Carotid Body Tumors
New Advances in Carotid Imaging Modalities
Review Questions
Answer Key
Conclusion
References
20 Carotid Duplex Consensus Criteria on Interpretation of Carotid Duplex Ultrasound
Introduction
Our Clinical Experience: Critical Appraisal of the Carotid Duplex Consensus Criteria in the Diagnosis of Carotid Artery Stenos...
Statistical Analysis
Results
ROC Analysis
Comments
Conclusions
Review Questions
Answer Key
References
21 Correlation of Doppler PSV >230 c/s to Positive Predictive Value in Predicting >70% and >80% Carotid Stenosis
Introduction
ICA PSV >230 cm/s in Detecting >70% Carotid Stenosis: Our Clinical Experience
Other Findings
ICA PSV >230 cm/s in Detecting >80% Carotid Stenosis
Comments
Conclusions
Review Questions
Answer Key
Cross-References
References
22 Incidence of Subclavian Steal as Detected by Carotid Duplex Ultrasound and Clinical Implications
Introduction
Prevalence
Etiology
Clinical Presentation
History
Physical Examination
Coronary Steal Syndrome
Imaging
Management
Our Clinical Experience
Summary
Review Questions
Answer Key
References
23 Duplex Ultrasound Surveillance After Carotid Endarterectomy
Introduction
Surveillance for Restenosis
Surveillance for Contralateral Disease
Surveillance Cost-Effectiveness
Surveillance Strategies
Duplex Ultrasound
Conclusion
Review Questions
Answer Key
Cross-References
References
24 Color Duplex Scanning on Other Miscellaneous Carotid Topics
Introduction
Role of Carotid Imaging in Asymptomatic/Carotid Bruit Patients
Role of Carotid Imaging in Patients with Atypical or Nonhemispheric Symptoms
Role of Carotid Imaging in Patients with Focal Neurologic Deficits (Transient Ischemic Attacks or Strokes)
Intraoperative Duplex Ultrasound Assessment of Carotid Endarterectomy
Intraoperative Monitoring of Carotid Endarterectomy with Transcranial Doppler Sonography
Role of Carotid Imaging in Patients Who Develop a Neurologic Deficit After Leaving the Operating Room
Postcarotid Endarterectomy Surveillance/Timing
Cost-Effectiveness of Postoperative Carotid Duplex Surveillance
The Value and Economic Analysis of Routine Postoperative Carotid Duplex Ultrasound Surveillance after CEA with Patch Closure
Proposed Duplex Velocity Criteria for Carotid Restenosis Following CEA with Patch Closure
Duplex Ultrasound Surveillance of Carotid Stents
Optimal Carotid Duplex Velocity Criteria for Defining the Severity of Carotid In-Stent Restenosis
Determination of Progression of Carotid Stenosis
Natural History of Carotid Artery Stenosis, Contralateral to Carotid Endarterectomy
Carotid Endarterectomy Based on Carotid Duplex Ultrasonography Without Angiography
Ultrasonic Carotid Plaque Morphology and Carotid Plaque Hemorrhage: Clinical Implications
Identifying High-Risk Carotid Plaque
Carotid Duplex Ultrasound After Neck Trauma
Carotid Duplex Ultrasound in Nonatherosclerotic Carotid Disease
Carotid Artery Dissection
Carotid Fibromuscular Dysplasia
True Carotid Artery Aneurysms
Carotid Pseudoaneurysms
Carotid Body Tumor
Role of Duplex Ultrasound in Vertebrobasilar Insufficiency
Color Duplex Ultrasound in the Diagnosis of Temporal Arteritis
Overall Accuracy of Noninvasive Vascular Testing
Multiple Choice Questions
Answer Key
Cross-References
References
Part IV: Noninvasive Diagnosis of Peripheral Arterial Disease of the Extremities
25 Overview of Peripheral Arterial Disease of the Lower Extremity
Introduction/Vascular Anatomy of the Lower Extremity
Collateral Circulation of the Lower Extremity
Normal Structure of the Arterial Wall
Incidence/Prevalence of Peripheral Arterial Disease
Risk Factors
Association of Peripheral Arterial Disease, Coronary Artery Disease, and Cerebrovascular Disease
Atherosclerosis
Pathophysiology
Theories of Atherosclerosis
Vascular Hemodynamic/Atherosclerosis
Clinical Manifestations of PAD
Natural History and Staging
Grade 0 (Asymptomatic)
Grade I (Claudication)
Grade II (Ischemic Rest Pain)
Grade III (Tissue Loss)
Diagnostic Investigation
History and Physical Examination
Noninvasive Tests
Overview of Noninvasive Testing in PAD
Doppler Ultrasound
Duplex Ultrasound and Color Flow Imaging
Plethysmography
Transcutaneous PO2
Laser Doppler Measurements
Electromagnetic Flowmeter
Magnetic Resonance Angiography
Computed Tomographic Angiography (CTA)
Catheter-Based Angiography
Treatment Options
Medical Therapy
Smoking Cessation
Weight Reduction
Treatment of Hyperlipidemia
Treatment of Hypertension
Treatment of Diabetes Mellitus
Exercise Therapy
Pharmacologic Therapy
Antiplatelet Drug Therapy
Surgical Therapy
Endovascular Therapy
Endovascular Therapy Versus Surgical Therapy
Review Questions
Answer Key
Cross-References
References
26 Segmental Doppler Pressures and Doppler Waveform Analysis in Peripheral Vascular Disease of the Lower Extremities
Introduction
Instrumentation and Physical Principles
Indications for Testing
Methods and Interpretations
Qualitative Doppler Waveform Analysis
Quantitative Interpretation Criteria of Doppler Waveform
Limitations of the Analog Wave Tracing Analysis
Segmental Doppler Pressures
Technique for Segmental Doppler Pressures
Interpretations
Thigh Pressure Indexes
Ankle-Brachial Index
Technique for Toe Doppler Systolic Pressure
Limitations and Sources of Error in Doppler Segmental Pressure Determination
Correlation of Segmental Doppler Pressure Results to Arteriography
Sensitivity and Specificity of the ABI in Diagnosing Peripheral Arterial Disease
Selective Use of Segmental Doppler Pressures and Color Duplex Imaging in the Localization of Arterial Occlusive Disease of the...
Summary
The Value of Stress Testing in the Diagnosis of Peripheral Arterial Disease
Treadmill Exercise
Technique
Interpretation
Clinical Studies
Test of Functional Capacity
Reactive Hyperemia
Review Questions
Answer Key
References
27 Pulse Volume Recording in the Diagnosis of Peripheral Vascular Disease
Introduction: History
Description of the Technique
Segmental Pressures
Pulse Volume Recordings
Specific Indications
Claudication
Rest Pain
Tissue Loss and Chronic Wound Healing
Amputation Healing
Contraindications
Interpretation
Segmental Pressures
PVR Reflected Wave
PVR Amplitude
Postexercise Measurements
Role of Adjunctive Vascular Imaging
Additional Applications of PVR Technology
Review Questions
Answer Key
Cross-References
References
28 Duplex Scanning for Lower Extremity Arterial Disease
Introduction
Evaluation of Peripheral Arterial Disease
Color Duplex Peripheral Arterial Examination
Duplex Criteria for Grading Occlusive Disease
Duplex Directed Endovascular and Surgical Intervention
Duplex Surveillance Following Endovascular or Surgical Procedures
Conclusion
Review Questions
Answer Key
Cross-References
References
29 Duplex Surveillance of Infrainguinal Bypass Grafts
Introduction
Mechanisms and Hemodynamics of Graft Failure
Arterial Bypass Hemodynamics
Intraoperative Duplex Scanning
Postoperative Graft Surveillance
Testing Intervals
Threshold Velocity Criteria for Graft Revision
Duplex Criteria for Endovascular Repair of Graft Stenosis
Predictors and Natural History of Graft Stenosis Development
Use of Balloon Angioplasty in Failing Grafts
The Future of Duplex Surveillance
Conclusion
Review Questions
Answer Key
References
30 Duplex Surveillance After Prosthetic Infrainguinal Bypass Grafting
Introduction
Natural History
Duplex Ultrasonography
Abnormal Findings
Indications for Interventions
Recommendation of Lifelong Surveillance
Summary
Review Questions
Answer Key
References
31 Rationale of Surveillance After Endovascular Intervention of Iliac and Femoral Arteries
Introduction
Rationale
Outcome Measures
Technical Considerations of Surveillance Following Endovascular Interventions
Surveillance Protocols
Determining the Surveillance Criteria for Lower Extremity Endovascular Stenting
Additional Studies to Determine Criteria for Lower Extremity Endovascular Stenting
Clinical Benefits of Duplex Surveillance
Future Directions
Conclusion
Questions
Answer Key
Cross-References
References
32 Lower Extremity Arterial Mapping: Duplex Ultrasound as an Alternative to Arteriography Prior to Femoral, Popliteal, and Inf...
Introduction
Arterial Examinations
Screening
Definitive Diagnosis
Preoperative Arterial Mapping
Aortoiliac Segment
Femoropopliteal Segment
Infrapopliteal Arteries
The Anastomotic Site
Vein Mapping
Posttreatment Follow-Up
Procedure Follow-Up
Patient Follow-Up
Implementation
Fundamental Objective
Learning Phase
Comparison with Arteriography
Virtual Decision-Making
Actual Decision-Making
Disadvantages of Ultrasonography
Advantages of Ultrasound Mapping
Conclusions
Questions: (Select one most appropriate answer)
Answer Key
References
33 Duplex Ultrasound: Evaluation and Management of Post-catheterization Femoral Pseudoaneurysms
Introduction
Classification and Incidence
Diagnosis
Treatment Options
Observation with Spontaneous Closure
Ultrasound-Guided Compression (UGC)
Ultrasound-Guided Thrombin Injection (UGTI)
Technical Tips
Experience from Our Institution
Surgical Intervention
Future Trends
Conclusions
Review Questions
Answer Key
References
34 Noninvasive Diagnosis of Upper Extremity Arterial Disease
Introduction
Presentation
Pathophysiology
Noninvasive Diagnostic Techniques
Segmental Arm Pressures
Plethysmography and Digital Pressure
Cold Challenge Testing
Upper Extremity Duplex Scanning
Interpretation
Additional Testing
Hemodialysis Access Evaluation
Hemodialysis Access Surveillance
Hemodialysis Access-Associated Steal Syndrome
Thoracic Outlet Syndrome
Conclusions
Review Questions
Answer Key
References
35 Duplex Ultrasound Imaging of the Radial Artery
Introduction
Anatomy of the Radial Artery
Protocol
Ultrasonographic Changes and Shifts in Flow Dynamics of the Radial Artery Seen in Systemic Disease
Coronary Artery Disease
End-Stage Renal Disease
Acute Ischemia
Radial Forearm Flaps
CME Questions
References
36 Vascular Laboratory Protocol and Ultrasound Mapping Techniques for Dialysis Access Planning
Introduction
History and Physical Exam
Arterial Exam
Venous Exam
Additional Examination
Diagnostic Imaging
Arterial Imaging
Segmental Arterial Pressure Measurements
Pulse Volume Recording (PVR)
Duplex Ultrasound (DU)
Duplex Ultrasound Venous Imaging
Superficial Venous System
Central Venous System
Conclusion
Review Questions
Answer Key
References
37 Color Duplex Ultrasound in Dialysis Access Surveillance
Introduction
Dialysis Access Diagnostics
Contrast Fistulography
Access Recirculation
Venous Line Pressure Measurement
Volume Flow Measurement
Duplex Ultrasound
Application of Duplex Surveillance
Guidelines for Dialysis Access Testing Using Duplex Ultrasound
Documentation
Diagnostic Criteria
Review Questions
Answer Key
References
38 Noninvasive Evaluation for Congenital Arteriovenous Fistulas and Malformations
Introduction
Historical Perspective
Initial Evaluation
Diagnostic Evaluation
Basic Considerations
Vascular Diagnostic Laboratory-Based Imaging
Segmental Limb Pressures
Segmental Plethysmography
Spectral and Velocity Waveform Analysis
Duplex Scanning
Integrating Duplex Ultrasound Physiologic Tests
Complementary Noninvasive Diagnostic Studies
Computer Tomography (CT) Scanning
Magnetic Resonance Imaging
Nuclear Medicine
Novel Diagnostic Methods
Review Questions
Answer Key
Conclusion
References
39 Noninvasive Vascular Testing in the Trauma Patient
Introduction
Mechanism of Injury
Diagnostic Evaluation
History
Physical Examination
Imaging Studies
Selective Angiography and Ankle-Brachial Indices
Plain Radiographs
Duplex Ultrasound
Computerized Tomographic Angiography
Magnetic Resonance Arteriography
Intravascular Ultrasound (IVUS)
Review Questions
Answer Key
Cross-References
References
40 Color Duplex Ultrasound for Diagnosis of Peripheral Artery Aneurysms (Lower and Upper Extremity)
Introduction
Lower Extremity
Clinical Presentation and Diagnosis
Treatment
Upper Extremity
Clinical Presentation and Diagnosis
Treatment
Summary
Review Questions
Answer Key
References
41 Color Duplex Ultrasound in Other Miscellaneous Arterial Topics
Screening: ``Does Peripheral Arterial Disease Exist?´´
Assessment of Location/Severity of Peripheral Vascular Disease
Correlation of ABI/General Atherosclerosis
Limitations of Resting ABI in the Diagnosis of Symptomatic PAD and the Role of Diabetes Mellitus and Chronic Kidney Disease
Perioperative Evaluation
Selection of the Arterial Reconstructive Procedure
Choice of Treatment Based on Duplex Scanning
Aortofemoral Popliteal Reconstruction
Profundaplasty and the Profunda Popliteal Index
Lumbar Sympathectomy
Healing of Ischemic Skin Lesions
Skin Perfusion Pressure as a Predictor of Ischemic Wound Healing Potential
Role of Vascular Laboratory in Selecting Amputation Sites
Skin Fluorescence
Doppler Systolic Pressure Determinations in Amputation Sites
Amputation Site Technique Selection
Compression Syndromes
Thoracic Outlet Syndrome
Popliteal Artery Entrapment Syndrome
Role of Vascular Lab in Penile Circulation
Doppler Technique
Duplex Imaging Techniques for Penile Circulation
Upper Extremity Ischemia and Vasospastic Diseases
Arteriovenous Malformations
Hemodialysis Access Graft Imaging
Technique
Interpretations
Volume Flow Criteria
Interpretation Pitfalls
Arterial Aneurysms
Endothelial Dysfunction
Review Questions
Answer Key
References
Part V: Noninvasive Diagnosis of Venous Disorders of the Extremities
42 Overview of Venous Disorders
Introduction
Anatomy
Venous Disorders
Acute Venous Disorders
Superficial Thrombophlebitis
Acute Deep Vein Thrombosis
Axillary-Subclavian Vein Thrombosis
Pulmonary Embolism (PE)
Testing for Pulmonary Embolism
Thrombosis of the Portal Venous System
Chronic Venous Disorders
Conclusion
Review Questions
Answer Key
References
43 Plethysmographic Techniques in the Diagnosis of Venous Disease
Introduction
Plethysmographic Measurement of Venous Obstruction
Plethysmographic Measurement of Venous Reflux
Strain-Gauge Plethysmography (SGP)
Impedance Plethysmography (IPG)
Photoplethysmography (PPG)
Air Plethysmography (APG)
Comparison of APG to PPG
Other Applications of APG
Influence of High-Heeled Shoes on Venous Function in Young Women Using APG
Ambulatory Venous Pressure, Air Plethysmography, and the Role of Calf Venous Pump in Chronic Venous Disease
APG and Venous Obstruction
Selective Use of Noninvasive Venous Studies
Review Questions
Answer Key
References
44 Color Venous Duplex Ultrasound of the Lower Extremity in the Diagnosis of Deep Venous Thrombosis
Introduction
Pathophysiology of Acute DVT
Venous Duplex Scanning
Indications
Instrumentation
Technique
Diagnosis of DVT
Reporting
Special Considerations
Questions: (Select one most appropriate answer)
Answer Key
Cross-References
References
45 Color Duplex for Diagnosis of Venous Reflux
Introduction
Technical Considerations
Technique Summary
VRD Interpretation
Site-Specific Ultrasound Examination
Great Saphenous and Accessory Saphenous Veins
Small Saphenous Vein and Its Thigh Extension
Perforator Veins
Deep Veins: Deep Thigh Veins: Popliteal Veins: Deep Crural Veins
Nonsaphenous Veins
Accurate Venous Duplex Scanning May Guide Length of Treatment Zone
Venous Duplex Ultrasound and Reflux Therapy
Limitations of Ultrasound
Conclusions
Review Questions
Answer Key
Cross-References
References
46 Venous Duplex Ultrasound of the Upper Extremities
Introduction
Imaging
Duplex Venous Scanning
Anatomy
Duplex Imaging Technique
Venous Abnormalities on Duplex Exam
Artifacts and Pitfalls
Upper Extremity DVT in Children
Soft-Tissue Abnormalities on Duplex Exam
Comparison of Upper and Lower Extremity DVT
Secondary Upper Extremity Thrombi
Treatment
Conclusions
Billing and Coding
Summary
Review Questions
Answer Key
References
47 Role of the Noninvasive Vascular Laboratory in Thoracic Outlet Syndrome
Introduction
Indirect Physiological Testing
Direct Testing with Duplex Ultrasound
TOS Ultrasound Evaluation
TOS Protocol
Venous TOS Protocol
Arterial TOS Protocol
Diagnostic Interpretation of TOS Duplex Examination
TOS Postoperative Protocol
Conclusion
Review Questions
Answer Key
Cross-References
References
48 Color Duplex Ultrasound-Guided Cava Filter Placement
Introduction
Clinical Decision-Making
Equipment
Pre-Procedural Imaging
Technique
Post-Procedure Considerations
Outcomes
Review Questions
Answer Key
References
49 Intravascular Ultrasound for Venous Stenting and Inferior Vena Cava Filter Insertion
Introduction
The IVUS Catheter Technique
Diagnostic Venous IVUS
IVUS Assistance During Stenting
Treatment of Acute DVT
IVUS and Placement of IVC Filters
Techniques of IVUS-Guided Filter Placement
Summary
Review Questions
Answer Key
Cross-References
References
50 The Role of Duplex Ultrasound Before, During, and After Endovenous Procedures
Preoperative Clinical Evaluation of Patients with Chronic Venous Insufficiency (CVI)
Noninvasive Vascular Lab
DU Equipment
DU Diagnostic Technique
Duplex Criteria for Abnormal Veins
Preoperative Duplex Ultrasound (DU) Imaging for CVI
Duplex Ultrasound During Venous Procedures
Truncal (Axial) Vein Endovenous Treatment
Initial Procedural Exam for Truncal Veins
Duplex Ultrasound During Thermal Ablation of Truncal Veins
Duplex Ultrasound During Superficial Venous Access and Sheath Placement
DU During Placement of an Ablation Catheter at the Truncal/Deep Vein Junction
DU-Guided Tumescence of Truncal Veins
DU During Confirmation of Successful Truncal Vein Ablation
DU During Foam Ablation of Truncal Veins
Endovenous Perforator Vein Treatment
Role of Duplex Ultrasound in Perforator Vein Ablation
Technique of DU During Perforator Vein Treatment
Post-procedure Duplex Ultrasound After Truncal Vein and Perforator Ablation
Confirmation of Successful Ablation Following Endovenous Procedures
Evaluation for Potential Complications Following Endovenous Ablation
Classification of EHIT
Summary
Review Questions
Answer Key
References
51 Preoperative Saphenous Vein Mapping
Introduction
Preoperative Imaging with Venography
Ultrasound Imaging of the Saphenous Vein
Method of Imaging
Great Saphenous Vein
Great Saphenous Vein Variants
Thigh Great Saphenous Vein Anatomy
Calf Great Saphenous Vein Anatomy
Small Saphenous Vein
Proper Use of Mapping Data
Review Questions
Answer Key
References
52 Role of Follow-Up Duplex Ultrasound Post-Deep Vein Thrombosis
Introduction
Best Test
Role of Follow-Up Duplex Ultrasound Following a Negative Initial Study
Limited Initial Study
Limited Initial Study During a Pandemic
Role of Follow-Up Duplex Ultrasound Post-Deep Vein Thrombosis
Isolated Calf Vein DVT
Determining Duration of Anticoagulation for DVT Therapy
Document Recurrent DVT
Risk Assessment Following Completion of Anticoagulation Therapy
The Future of VTE Care and the Role of Follow-Up Duplex Imaging
Conclusion
Review Questions
Answer Key
References
53 Role of Duplex Ultrasound Screening/Surveillance in High-Risk Deep Vein Thrombosis Patients
Introduction
Identifying High-Risk Patients
Laboratory and Imaging Studies
Conclusions
Review Questions
Answer Key
Cross-References
References
Part VI: Noninvasive Diagnosis of Abdominal/Visceral Arteries
54 Color Duplex Scanning of the Hepatoportal Circulation
Introduction
Instrumentation and Technique
Anatomy and Normal Doppler
Hepatic artery
Portal veins
Hepatic Veins
Role of Doppler in Assessment of the Liver
Abnormalities of the Hepatic Artery
Abnormalities of the Portal Venous System
Altered Portal Venous Hemodynamics
Portal Hypertension
Portosystemic Shunts with Portal Hypertension
Transjugular Intrahepatic Portosystemic Shunts (TIPS)
Portal Vein Thrombosis
Portal Vein Air
Abnormalities of the Hepatic Veins
Abnormal Hepatic Venous Waveforms
Budd-Chiari Syndrome
Sinusoidal Obstruction Syndrome
Multiple Choice Questions for Chapter 46
Answer Key
References
55 Color Duplex Scanning of the Renal Arteries
Introduction
Etiology of Renal Artery Disease
Renal Duplex Sonography
Duplex Sonographic Evaluation of the Renal Arteries
Anatomy of the Renal Arterial System
Technique
Patient Preparation and Positioning
Equipment
Examination of the Aorta and Mesenteric and Renal Arteries
Evaluation of Renal Parenchymal Blood Flow
Measurement of Renal Size
Evaluation for Renal Vein Thrombosis
Contrast-Enhanced Imaging
Special Considerations
Accessory and Multiple Renal Arteries
Occlusion of the Main Renal Artery
Horseshoe Kidney
Renal Artery Aneurysms
Fibromuscular Dysplasia
Renal Artery Bypass
Renal Artery Stents
Interpretation of Doppler Spectral Waveforms and Images
The Abdominal Aorta
Normal Renal Artery
Renal Artery Stenosis of Less Than Hemodynamic Significance (<60%)
Hemodynamically Significant Renal Artery Stenosis
Renal Artery Occlusion
Renal Parenchymal Dysfunction (Medical Renal Disease)
Renal Hilar Evaluations
Renal Vein Evaluation
Evaluation of Renal Artery Stents
Prediction of Outcome of Interventions for Renal Artery Stenosis
Pediatric Renal Duplex Evaluations
Pediatric Renal Artery Anatomy
Technique
Patient Preparation and Positioning
Diagnostic Criteria
Conclusion
Review Questions
Answer Key
Cross-References
References
56 Duplex Ultrasound of Renal Transplants
Introduction
Surgical Technique
Normal Ultrasound Findings
Complications
Immediate (Within 48 h)
Acute Tubular Necrosis
Renal Vein Thrombosis
Renal Artery Thrombosis
Compartment Syndrome
Hyperacute Rejection
Early (1 Week to 1 Month)
Acute Rejection
Urinary Tract Obstruction
Delayed (>1 Month)
Chronic Rejection
Medication Toxicity
Renal Artery Stenosis
Renal Vein Stenosis
Pseudoaneurysms and Arteriovenous Fistulas
Neoplasm
Anytime
Fluid Collections
Torsion of the Renal Transplant
Urinary Tract Infection
Infarct
Future Directions
Conclusion
Review Questions
Answer Key
References
57 Duplex Evaluation After Renal Artery Intervention
Introduction
Renal Duplex Sonography Before Renal Artery Repair and Intervention
Intraoperative Duplex Sonography
Technique
Renal Duplex Sonography After Open Operative Repair of Renovascular Disease
Renal Duplex Sonography After Renal Artery Angioplasty and Stenting
Conclusion
Review Questions
Answer Key
References
58 Duplex Ultrasonography of the Mesenteric Circulation
Mesenteric Duplex Scanning: Technique
Normal Findings
Clinical Applications
Physiologic Measurements
Visceral Aneurysms
Celiac Artery Compression Syndrome (Median Arcuate Ligament Syndrome)
Visceral Ischemic Syndromes
Perioperative Applications
Intraoperative Applications
Postoperative Applications
Endovascular Intervention
Acute Mesenteric Ischemia
Image Enhancement
Population Screening
Conclusion
Review Questions
Answer Key
References
59 Color Duplex Scanning of Superior Mesenteric and Celiac Artery Stenting
Our Clinical Experience
Patient Population and Methods
Duplex Protocol
Results
ROC Analyses
Discussion
Conclusions
Review Questions
Answer Key
References
60 The Role of Color Duplex Ultrasound in Patients with Abdominal Aortic Aneurysms
Introduction
Imaging for Abdominal Aortic Aneurysm
History of AAA Imaging
Ultrasound for AAA Imaging
CT Scanning for AAA Imaging
Additional AAA Imaging Techniques
Ultrasound Versus CT for AAA
Aortic Ultrasound Technique
Indications for Aortic Ultrasound
Equipment
Patient Preparation
B-Mode Imaging
Pulsed Doppler
Color Doppler
Aneurysm Sac
Ultrasound Contrast
Summary
Review Questions
Answer Key
References
61 Clinical Validation of Three-Dimensional Ultrasound for Diagnosis of Abdominal Aortic Aneurysm
Introduction
3D Ultrasound for Diagnosis and Surveillance
3D Ultrasound for Surveillance After Endovascular Aortic Repair (EVAR)
Review Questions
Answers
References
62 Duplex Ultrasound Screening for Abdominal Aortic Aneurysm
Introduction
Choosing the Best Screening Test: Duplex Ultrasound Versus Other Modalities
Duplex Ultrasound Test Accuracy
Duplex Ultrasound Test Cost
Other Tests
Physical Examination
Abdominal X-Ray
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA)
Who to Screen?
AAA Disease Incidence and Prevalence
Reduction in Morbidity/Mortality Associated with Duplex Ultrasound
Chichester AAA Screening Program [33, 34]
Viborg Study of AAA Screening [35, 36]
Multicentre Aneurysm Screening Study (MASS) [6, 19]
Western Australia AAA Program [4]
Potential Harm Associated with AAA Screening
Current Screening Recommendations
Considerations for Broader AAA Screening
Current Duplex Ultrasound Screening Utilization
Surveillance After Screening
Duplex Technique
Summary
Review Questions
Answer Key
Cross-References
References
63 Role of Color Duplex Ultrasound for Aortic Endografts
Introduction
Published Literature
US for AAA Diameter Measurement
US for Endoleak Detection
US for Iliac Limb Follow-Up
Contrast-Enhanced Ultrasound (CEUS)
Cost Considerations
Current Societal Guidelines
Imaging Technique
Patient Preparation and Positioning
Examination Guidelines
Stent Graft Evaluation Post EVAR
Surveillance Policy Changes
Conclusion
Review Questions
Answer Key
References
64 Role of CT Angiography in Pre- and Postabdominal Aortic Aneurysm Endovascular Grafts
Introduction
Fundamentals of a CT Scan
Diagnosis, Surveillance, and Preoperative Planning
Postabdminal Aortic Aneurysm Intervention Surveillance
Endoleak Diagnosis and Management
Type 1 Endoleak
Type 2 Endoleak
Type 3 Endoleak
Type 4 Endoleak
Type 5 Endoleak
Limitations and Risks
Contrast-Induced Nephropathy
Radiation Exposure
Review Questions
Answer Key
Cross-References
References
Part VII: Miscellaneous
65 Transcutaneous Oxygen Tension: Principles and Applications
Introduction
Definition
Applications
Physiology/Evolution of the Technique
Clinical Applications of TcpO2
Assessing Wound Healing Potential
Screening for Chronic Vascular Disease and Assessing the Success of Revascularization
Predicting the Amputation Level
Prospective Treatment of Diabetic Foot Problems
Predicting the Benefit of Hyperbaric Oxygen (HBO)
TcpO2 as a Guide to Decision-Making
Other Applications for TcpO2
Conclusions
Review Questions
Answer Key
References
66 Three-Dimensional Vascular Imaging and Power Doppler Angiographic Imaging
Introduction
Three-Dimensional Power Doppler Angiography
Limitations of Power Doppler Angiography
Other Clinical Applications of 3-D Vascular Ultrasound
3-D Imaging with Contrast Agents
3-D Intravascular Ultrasound
Future of Three-Dimensional Vascular Imaging and Power Doppler Angiography
Review Questions
Answer Key
References
67 Contrast-Enhanced Ultrasound
Introduction
Basic Principles of Contrast-Enhanced Ultrasound Agents
Mechanics of Ultrasonographic Contrast
Low Acoustic Power (MI <0.1)
Intermediate Acoustic Power (0.1< MI <0.5)
High Acoustic Power (MI >0.5)
Microbubble Technology
Ultrasound Imaging Techniques
B-Mode and Color Imaging
Stimulated Acoustic Emission
Contrast-Enhanced Dynamic Flow
Harmonic Imaging
Flash Echo Imaging
Real-Time Digital Subtraction
Clinical Applications of Ultrasound Contrast Agents
Assessment of Vascular Abnormalities
Renovascular Assessment
Echocardiography
Other Applications
Plaque Assessment
Mesenteric Evaluation
Carotid Assessment
Aortic Evaluation: Abdominal Aortic Aneurysm (AAA)
Lower-Limb Evaluation
Molecular Imaging Using Contrast-Enhanced Ultrasound: Evaluation of Angiogenesis and Cell Therapy
Applications in Venous System
Assessment of Portal Vein Thrombosis
Venous Vascularization and Inflammation on CEUS in Deep Venous Thrombosis: Ongoing Clinical Trial
Future Directions
Work in Progress
Conclusion
Review Questions
Answer Key
References
68 Arterial and Venous Intravascular Ultrasound Applications
Introduction
Technical Aspects of Intravascular Ultrasound Applications and Peripheral Interventions
Performing a Pullback
Operative and Anatomic Situations
Carotid Angioplasty and Stenting
Thoracic Aorta
Abdominal Aorta
Iliac Arteries
Infrainguinal Arteries
Venous IVUS
Discussion
Conclusions
Review Questions
Answer Key
References
69 Coding and Reimbursement for Vascular Lab Testing
Introduction
Reporting Based on Site of Service: Physician´s Office
Site of Service: IDTF
Site of Service: Hospital Outpatient and Inpatient
Vascular Lab Coverage, Coverage Denials, and Advanced Beneficiary Notice
Vascular Lab Retrievable Data
Reimbursement for Physician Interpretation
Complete Versus Limited Vascular Studies
The Deficit Reduction Act Limits Office-Based Technical Reimbursement
G Codes
Intima-Media Thickness: A Non-covered Code
New Vascular Lab CPT Codes
Conclusion
Review Questions
Answer Key
References
70 Clinical Application of Ultrasound Guidance in Arterial and Venous Access
Introduction
Central Venous Access
Internal Jugular Vein
Subclavian Vein
Femoral Vein
Popliteal and Tibial Veins
Peripheral Venous Access
Great and Small Saphenous Veins
Basilic Vein
Arterial Access
Common Femoral Artery
Popliteal Artery
Brachial Artery
Radial Artery
Conclusion
Review Questions
Answer Key
References
71 Computed Tomographic Angiography in the Diagnosis of Peripheral Arterial Disease
History and Basic Concept
Image Postprocessing Tools
Radiation Dose
Iodinated Contrast Reactions
CTA Versus MRA and DSA
Review Questions
Answer Key
Cross-References
Reference
72 Magnetic Resonance Angiography in the Diagnosis of Peripheral Arterial Disease
Introduction
Background
Basics of Magnetic Resonance Imaging
Magnetic Resonance Angiography Equipment
Non-contrast-Enhanced Magnetic Resonance Angiography
Contrast-Enhanced Magnetic Resonance Angiography
Magnetic Resonance Angiography Compared to Other Imaging Modalities
Limitations of Peripheral Magnetic Resonance Angiography
Magnetic Resonance Angiography in Special Populations
Review Questions
Answer Key
Cross-References
References
Index