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Objective: Venous leg ulcers (VLUs) are often large and complicated wounds that, despite combinations of advanced wound care techniques and systemic treatment of underlying vascular issues, take many months to heal and have high rates of recurrence. In this study, we investigated the efficacy of a novel wound care solution—human keratin matrix (HKM). Method: A case series of VLUs were treated with HKM in conjunction with indicated vascular intervention and standard of care (SoC) procedures. For analysis, these wounds were divided into very large (>200 cm2) and smaller (<35 cm2) wounds. Results: The cohort comprised 16 VLUs (very large=7; smaller=9). Very large VLUs were reduced in size by an average of 71% within 10 weeks, and showed a 50% size reduction within four applications of HKM. Smaller VLUs reduced by 50% in size within the first three weeks of treatment, and 88.9% of these wounds healed completely with an average of 4.5 HKM applications over an average of 6.5 weeks. Conclusion: The results of this series highlight the potential of HKM, in combination with indicated systemic interventions and SoC, as an effective treatment for hard-to-heal (chronic) VLUs, even in very large wounds. [ABSTRACT FROM AUTHOR]

The American Institute of Ultrasound in Medicine (AIUM) revised the Practice Parameter for the Performance of Vascular Ultrasound for Postoperative Assessment of Hemodialysis Access in collaboration with other organizations. The document provides recommendations for personnel requirements, documentation, quality assurance, and safety for ultrasound examinations. It addresses the importance of monitoring hemodialysis access to detect complications and ensure proper function, with specific guidelines for evaluating AVFs and grafts. The parameter emphasizes the need for accurate documentation, equipment specifications, and adherence to quality and safety standards in ultrasound practices. [Extracted from the article]

Background: Diabetes mellitus affects the whole vascular system, leading to both microvascular and macrovascular complications [1]. Diabetic nephropathy is the dreadful microvascular complication of diabetes mellitus, which lead to end stage kidney disease (ESKD), which increase the risk of cardiovascular mortality [2]. Duplex sonography of the renal artery provides an easily applicable, non-invasive, and well-established way to assess changes in renal vasculature caused by diabetes [5]. In this study, detecting subtle changes in renal vasculature with renal artery Doppler, particularly RI (RESISITIVE INDEX) values, and correlating with biochemical parameters such as creatinine, and urine albumin, helps the physician for accurate management of diabetes patients preventing complications. Objective: Evaluation of renal sono-morphological characteristics using gray scale ultrasound and renal vascular resistance by doppler in patients with diabetic renal disease. Correlation among renal ultrasound, colour doppler, and biochemical parameters in diabetic renal disease. Methods: A time-bound, cross-sectional study, was conducted in the Department of Radio-diagnosis, M.G.M. Medical College and M.Y. Associate Hospital, Indore, Madhya Pradesh, India after receiving approval from Institutional Scientific and Ethical Committee. The duration of the study was from September 2022 to September 2023. A total of 108 patients of type II diabetes mellitus were included in the study. Results: out of total 108 of patients who were diagnosed with type II diabetes mellitus, maximum no of patients (28.7%) in age group of 50-60 years. In our study, male preponderance was observed in our study with 65.74% patients being male. On basis of biochemical parameters divided in 4 subgroups majority of patients 38% were fall under subgroup IV (renal failure) followed by subgroup I(preclinical) 27.8 %, subgroup II (incipient nephropathy) 18.5% and subgroup III (overt nephropathy) 18.5%. Majority of patients in subgroup IV (renal failure) 76.2 to 81.5% revealed gradeII/III renal parenchymal echogenicity changes. In our study most of the patients belonging to subgroup I (80%) had normal RI value while most of the patients belonging to subgroup II (70%), subgroup III (80%) and subgroups IV (94.74%) had increased RI values indicating raised renal vascular resistance as the disease progresses. R.I shows strong positive correlations with Blood Urea Nitrogen (BUN), Urine protein (Alb) and Creatinine levels higher R.I may coincide with elevated levels of these renal function markers. Conclusion: our study demonstrates Renal Doppler is a non-invasive modality that can be used in association with biochemical parameters of patients with diabetic nephropathy. An increasing intra-renal resistive index value could prompt the physician to a more rigid control of blood sugars and hypertension in this subgroup of diabetic patients delaying the progression to end-stage renal failure. [ABSTRACT FROM AUTHOR]

Objective: To review the current approaches to the diagnosis of Post-Thrombotic Syndrome (PTS) and to evaluate the potential need for a diagnostic tool. Method: Medical specialists were invited to participate in an online survey of their current approaches to the diagnosis and management of PTS, including the use of scoring systems, diagnostic imaging techniques and the extent the practitioner reviews the patient's venous history. Results: 502 participants completed the survey. Over 80% obtained imaging reports to confirm a history of deep vein thrombosis (DVT). 72% of participants always obtained an up-to-date duplex ultrasound for PTS diagnosis. Over 50% did not use a scoring system for either PTS diagnosis or management. 65% of the participants agreed that a new system for PTS diagnosis should be devised. Conclusion: Heterogeneity was observed in methods of diagnosing PTS by medical practitioners with frequent use of medical imaging studies and moderate use of scoring systems. Development of a new diagnostic tool for PTS should be considered for future studies. [ABSTRACT FROM AUTHOR]

The Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial results suggest that in patients with chronic limb-threatening ischemia (CLTI) and adequate single-segment great saphenous vein (SSGSV) by preoperative duplex ultrasonography, a surgical-first treatment strategy is superior to an endovascular-first strategy. However, the utilization of vein mapping prior to endovascular-first revascularization for CLTI in actual clinical practice is not known. Data from a multicenter clinical data warehouse (2008-2019) were linked to Medicare claims data for patients undergoing endovascular-first treatment of infra-inguinal CLTI. Only patients who would have otherwise been eligible for enrollment in BEST-CLI were included. Adequate SSGSV was defined as healthy vein >3.0 mm in diameter from the groin through the knee. Logistic regression was used to estimate associations between preprocedure characteristics and vein mapping. Survival methods were used to estimate the risk of major adverse limb events and death. A total of 142 candidates for either surgical or endovascular treatment underwent endovascular-first management of CLTI. Ultrasound assessment for SSGSV was not performed in 76% of patients prior to endovascular-first revascularization. Of those who underwent preprocedure vein mapping, 44% had adequate SSGSV for bypass. Within one year postprocedure, 12.0% (95% confidence interval 7.4-18.0%) of patients underwent open surgical bypass and 54.7% (95% confidence interval 45.3-62.4%) experienced a major adverse limb event or death. In a real-world cohort of BEST-CLI–eligible patients undergoing endovascular-first intervention for infra-inguinal CLTI, three-quarters of patients had no preprocedure ultrasound assessment of great saphenous vein conduit. Practice patterns for vein conduit assessment in the real-world warrant reconsideration in the context of BEST-CLI trial results. [ABSTRACT FROM AUTHOR]

Objective: Lower extremity edema is characteristic of C3 chronic venous disease. We developed a new clinical and duplex ultrasound (DUS) methodology for the detection and quantification of leg edema and prospectively evaluated its usefulness. Methods: Forty-seven venous patients (94 legs) were evaluated for ankle edema using an Edema RulerTM and DUS using a modified Suehiro grading scale. Results: Interobserver reliability for the use of the Edema RulerTM was 0.985 (p <.001) and 0.883 (p <.001) for the Modified Suehiro Grade. The Edema RulerTM had stronger significant correlations with Edema rVCSS (0.842; p <.001) compared to DUS: (0.474; p <.001) with Edema rVCSS. There were significant differences between the edema pitting depth in CEAP classification of C1 and C2 compared to C3, C4a, and C4c. DUS analysis only had significant differences between CEAP classification C2 and C4a. Conclusions: The Edema RulerTM provides a quantitative measurement of lower extremity edema with high reliability which can be easily integrated into clinical practice. While both methods had good inter-observer reliability, the Edema RulerTM had stronger correlations to Edema rVCSS and showed significant differences in pitting depths between lower CEAP scores (C1-2) compared to higher CEAP scores (C3-4c). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to validate the efficiency of Doppler ultrasonography for predicting the innominate, subclavian, and common carotid artery stenosis. Methods: This retrospective multicenter study between 2013 and 2022 enrolled 636 patients who underwent carotid Doppler ultrasonography and subsequent digital subtraction angiography. And 58 innominate artery stenosis, 147 common carotid artery stenosis, and 154 subclavian artery stenosis were included. The peak systolic velocity at innominate, subclavian, and common carotid artery, and velocity ratios of innominate artery to common carotid artery, innominate artery to subclavian artery, and common carotid artery to internal carotid artery were measured or calculated. The threshold values were determined using receiver operating characteristic analysis. Results: The threshold values of innominate artery stenosis were peak systolic velocity >206 cm/s (sensitivity: 82.8%; specificity: 91.4%) to predict ≥50% stenosis and >285 cm/s (sensitivity: 89.2%; specificity: 94.9%) to predict ≥70% stenosis. The threshold values of common carotid artery stenosis were peak systolic velocity >175 cm/s (sensitivity: 78.2%; specificity: 91.9%) to predict ≥50% stenosis and >255 cm/s (sensitivity: 87.1%; specificity: 87.2%) to predict ≥70% stenosis. The threshold values of subclavian artery stenosis were peak systolic velocity >200 cm/s (sensitivity: 68.2%; specificity: 84.4%) to predict ≥50% stenosis and >305 cm/s (sensitivity: 57.9%; specificity: 91.4%) to predict ≥70% stenosis. Conclusions: Symptomatic patients with ultrasonic parameters of velocity at innominate artery ≥206 cm/s, velocity at common carotid artery ≥175 cm/s, or velocity at subclavian artery ≥200 cm/s need to be considered for further verification and whether revascularization is necessary. [ABSTRACT FROM AUTHOR]

Popliteal entrapment syndrome (PES) describes a cluster of symptoms related to the compression of the neurovascular bundle in the popliteal fossa, most commonly involving the popliteal artery. In approximately 10-15% of the cases of popliteal entrapment syndrome, the popliteal vein is compressed. Symptoms of popliteal vein entrapment can mimic venous insufficiency or deep venous thrombosis, causing the diagnosis to be missed or delayed. Diagnosis of popliteal vein entrapment can be done with duplex imaging with flexion and extension maneuvers; however, venography is the gold standard for diagnosis. While popliteal vein entrapment is commonly associated with younger individuals, it may also be an underdiagnosed condition in older patients. We describe two cases of successful diagnosis and treatment of late-onset presentation of popliteal vein entrapment. [ABSTRACT FROM AUTHOR]

Background: Performing reproducible flow-mediated dilatation (FMD) measurements can be challenging, especially among inexperienced operators. Our aim was to present the detailed learning curve of a novice operator. Methods: Following a one-week basic training period, the operator performed duplicate measurements on 6–8 individuals per week, for six weeks. The operator followed the recommendations of the most recent guideline. Duplex ultrasound was used for the simultaneous and continuous measurement of brachial artery diameter and local blood flow velocity. Following a 1-min recording of baseline diameter (D), FMD was measured after a 5-min period of occlusion of the proximal forearm vessels. Inter-session coefficient of variation (CV) values for D and FMD were calculated for each week. Results: The number of volunteers assessed each week were the following: 8, 7, 7, 6, 7, 7 individuals. CV values for both D and FMD exhibited a decreasing trend over the training period, ending at 1.73% for D and 14.24% for FMD at week 6. These CV values are within the range outlined in the most recent FMD guideline for proficiency. Conclusion: Within a reasonable timeframe, and with careful adherence to measurement guidelines, the attainment of sound reproducibility in FMD measurements by a novice operator is feasible. [ABSTRACT FROM AUTHOR]

\nIntroduction: The objective of this study was to explore the association between net vertebral artery flow volume (NVAFV), calculated through color duplex ultrasonography, and posterior circulation infarction (PCI) in patients with severe intracranial vertebral artery (VA) stenosis. Methods: 234 patients with severe intracranial VA stenosis (≥70%) were categorized into the PCI group (n = 139) and the non-PCI group (n = 95) based on cranial MRI diagnosis. The correlation between NVAFV and CT perfusion data was analyzed, and the occurrence of PCI under diverse PCI mechanisms was also investigated. Multifactorial logistic regression and stratified analysis was performed to analyze the association between NVAFV and PCI. Lastly, generalized additive models and smooth curve fitting was utilized to outline relationship between NVAFV and PCI. Results: NVAFV showed a significant correlation with cerebral blood flow, mean transmit time, and time to peak. In the large artery atherosclerosis mechanism, a reduction in NVAFV correlated with a gradual rise in PCI cases (p = 0.002), while this trend lacked significance in the branch artery occlusive disease mechanism (p = 0.993). In the fully adjusted model, each 10 mL/min increase in NVAFV reduced PCI incidence by 11% (OR 0.890, 95% CI 0.840–0.943, p < 0.001), Sensitivity analysis showed similar results; NVAFV presented different PCI risks among various glucose level subgroups, the OR (95% CI) for PCI was 0.788 (0.684, 0.906) in low-glucose group (T1), 0.968 (0.878, 1.066) in moderate-glucose group (T2), and 0.886 (0.801, 0.979) in high-glucose group (T3). Smooth curve fitting demonstrated a linear negative association between NVAFV and PCI. Conclusion: NVAFV demonstrated an association with PCI in patients with severe intracranial VA stenosis, it can serve as a reference for identifying high-risk populations of PCI; however, it must be considered in combination with glucose. This study investigates the relationship between vertebral artery (VA) blood flow and posterior circulation infarctions (PCI), which are strokes in the back of the brain. VAs play a crucial role in supplying blood to this area. Using color duplex ultrasonography, we measured blood flow in 234 patients with severe VA narrowing (≥70%). These patients were divided into two groups: those who had experienced PCI and those who had not. We analyzed the correlation between blood flow in the VAs and various brain imaging data to understand the occurrence of PCI under different conditions. The findings showed that lower blood flow through the VAs was significantly associated with a higher risk of PCI, particularly in cases involving large artery atherosclerosis (a type of artery disease). However, this association was not observed in cases of branch artery occlusive disease. A detailed analysis revealed that for every 10 mL/min increase in blood flow, the risk of PCI decreased by 11%. This relationship also varied according to the patients’ blood glucose levels: patients with lower blood glucose levels showed a stronger link between increased blood flow and reduced PCI risk compared to those with moderate or high blood glucose levels. In conclusion, measuring the blood flow in the VAs can help identify patients at high risk of strokes in the back part of the brain. However, it is important to consider this measurement in combination with blood glucose levels to improve the identification of high-risk patients. [ABSTRACT FROM AUTHOR]

Background Glaucoma is a chronic, progressive optic neuropathy caused by multi-factorial aetiology which leads to damage of the optic nerve & produces visual field damage resulting in a characteristic appearance of the optic disc. The overall prevalence of glaucoma in Asia has been found to be in between 2.1% to 5%. The average age of all patients with glaucoma is between 56.05 years to 57.83 years. The fact that the retro bulbar circulation originates from internal carotid arteries which are directly accessible to ultrasound study through grey scale, colour Doppler flow imaging (CDI) & spectral Doppler imaging gives us a potential tool for the evaluation of early changes in vascular flow related to glaucoma. The present study aims to evaluate the carotid artery abnormalities by sonography in glaucoma patients & age matched controls. Methods A hospital based case control study, was conducted in the department of Radiodiagnosis, M.G.M Medical College and M.Y Hospital and associated hospitals, Indore, Madhya Pradesh India, November 2022 to November 2023. A total of 95 glaucomatous eyes were included as study groups & 95 age matched non-glaucomatous eyes were included in the control groups. Patients with increased IOP with or without visual field defects were referred to the department of radiodiagnosis for the evaluation of the hemodynamics of the retro orbital & carotid vessels were recruited in the study. All examinations of carotid artery color doppler and orbital artery color doppler were performed using a high frequency linear-array transducer (7-13 MHz) that provides high resolution image. Results Among the all patients, 31.5% were belongs to 7th decade of life, with a male predominance (54%). Diminishing of vision was the most common clinical finding. 7.36% of the patients in our study group had hemodynamically significant (>50%) ICA stenosis compared to 1.05% of the patients in control group as per consensus criteria, significant correlation was observed between degrees of carotid artery stenosis with CRA PSV (p value-0.021), CRA EDV (p value0.034) & CRA RI (0.038). and significant correlation was observed between degrees of carotid artery stenosis with PCA PSV (p value-0.015) & PCA EDV (0.031) & PCA RI (p value- 0.039). Conclusion This study reveals that Doppler ultrasound of the carotid artery is a non-invasive way to evaluate blood flow in the main vessels supplying blood to the eyes and brain. Parameters such as peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) are measured to gain insights into potential changes in blood flow associated with glaucoma. The research emphasizes the presence of vascular dysfunction in glaucoma & a strong link between glaucoma and impaired carotid artery blood flow. [ABSTRACT FROM AUTHOR]

Arteriovenous fistulas (AVFs) of the lower extremity are uncommon. The main causes are traumatic or iatrogenic, with 15% of traumatic AVFs occurring in the popliteal vessels. Herein, we present a 60-year–old female with a traumatic AVF caused after a car accident 40 years ago. The patient presented with right leg venous claudication and symptoms of congestive heart failure. Duplex ultrasound of lower limb vessels revealed an AVF at the distal part of the tibiofibular trunk. The patient was successfully managed with an endovascular approach using a coil-assisted covered endovascular repair technique of the tibiofibular bifurcation (CERTIFIB) with excellent results and distal vessels patency. At 3 months follow-up, patient presented with an impressive regression of 3 cm of the lower extremity oedema and improvement of both claudication and heart failure. [ABSTRACT FROM AUTHOR]

In this series of articles with comments and illustrations on the World Federation for Medicine and Biology (WFUMB) guidelines on contrast-enhanced ultrasound (CEUS) the topics of very rare focal liver lesions (FLL) are discussed. Improving the detection and characterization of the most common FLL are the main topics of these guidelines. The focus of this review is on the many manifestations of cystic fibrosis-related liver disease (CFLD). These include focal biliary fibrosis, liver cirrhosis, vascular manifestations with nodular regenerative hyperplasia and portal hypertension with or without cirrhosis. This article describes the diverse changes of liver involvement in cystic fibrosis and their appearance on ultrasound, duplex sonography, and contrast enhanced ultrasonography. This knowledge and the imaging should help to recognize liver manifestations in time and enable a correct interpretation of ultrasound images in CF in the corresponding clinical situation. [ABSTRACT FROM AUTHOR]

Traumatic arteriovenous fistula (AVF) is not a common disorder, and dermatological signs and heart failure caused by AVF are rarely reported. We present the case of a 55-year-old woman who was referred for congestive heart failure symptoms. Echocardiography revealed preserved left ventricular ejection fraction. Due to edema of the right leg with a long-standing leg ulcer and palpable femoral thrill, duplex ultrasonography was performed. It showed an AVF between the right superficial femoral artery (SFA) and the right femoral vein (FV). The patient recalled a 32-year-old gunshot injury that was not medically treated. After the diagnosis of AVF she was referred to a surgeon for an AVF ligation, with subsequent resolution of her symptoms. The differential diagnosis of leg ulcer with leg edema should include the possibility of AVF as a cause. [ABSTRACT FROM AUTHOR]

Saphenopopliteal junction classification has been developing, but still the precise knowledge of junction type is crucial for proper surgical treatment. We examined the saphenopopliteal junction by duplex venous scanning in 244 extremities in healthy volunteers (median age: 23.0 years, 83 females, 39 male) and performed a meta-analysis of 13 studies focusing on structural types of the junction. According to Schweighoffer's classification we distinguished 5 types of the junction and we subdivided type A according to Cavezzi's classification of gastrocnemial veins termination into two. We added type F (small saphenous vein-SSV terminates into popliteal vein-PV), described especially in cadaveric studies. In our study, the most frequent type was A1 (96 cases), followed by C (70), B (48), A2 (20), E (6), D (3) and F (0). The pooled prevalence estimate for types A + B + D + E was 54.7% (95% CI 40.9–69.6%) and for type C 24.4% (95% CI 19.3–29.5%), whereas in 17.1% (95% CI 6.3–27.9%) of cases, the SSV terminated in the PV with no cranial extension present. The knowledge of the saphenopopliteal junction and its variations prevalence can help clinicians to quickly identify the real type of the junction during routine examination. In mid-European population, the main type is A1 and worldwide type A. [ABSTRACT FROM AUTHOR]

Objective: The presence of peripheral artery disease (PAD) in patients with diabetic foot ulcers (DFUs) is a significant risk factor for chronicity and amputation. Ankle–brachial pressure index (ABPI) is a screening tool for PAD. Brachial systolic pressure measurement, used as a denominator in the calculation of ABPI, produces inaccurate results in patients with obesity and the presence of heavy clothing. The wrist, however, is easily accessible, and the ankle–wrist pressure index (AWPI), if comparable with ABPI, may be useful in screening selected patients. This study aimed to assess the efficacy of AWPI in diagnosing perfusion in DFUs and compare it to ABPI in patients with DFUs. Method: ABPI and AWPI were calculated by measuring systolic blood pressure in the arteries of the ankle, arm and wrist with a handheld Doppler. Actual perfusion was determined by the presence or absence of PAD by duplex ultrasound. Results: A total of 46 lower extremities in 41 patients were studied. The prevalence of PAD was 61%. Duplex ultrasound confirmed that the sensitivity of ABPI and AWPI in detecting PAD in patients with DFUs was 67.9% and 71.4% respectively, whereas the specificity of ABPI and AWPI was 94.4% and 88.9% respectively. On receiver operating characteristic analysis, the area under the curve of ABPI and AWPI was 0.804 and 0.795, respectively. A statistically significant positive correlation between ABPI and AWPI was found (r=0.986; p<0.001). Conclusion: There was a good correlation between ABPI and AWPI over a wide range of values. ABPI and AWPI may have a similar role in predicting perfusion in patients with DFUs. AWPI could be used in place of ABPI in selected patients in whom measuring ABPI may be difficult. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to demonstrate the sonographic and computed tomographic features of venous pseudoaneurysms and show the difference between true and false venous aneurysms and arterial pseudoaneurysms. Likewise, it was important to provide a historical context based on a literature review of vascular aneurysms and pseudoaneurysms, emphasizing venous pseudoaneurysms. Materials and Methods: Clinical cases are presented for context, and the vascular examinations were performed utilizing a General Electric (GE) Logiq Fortis or Logiq S8 scanners with a broad-band linear-array transducer (L2-9). Computed tomography (CT) with contrast was performed on a GE Revolution Maxima 64-slice CT scanner with 100 mL Omnipaque-350 as a contrast agent. The three-dimensional (3D) axial, sagittal, and coronal reconstructions were made with the Philips IntelliSpace software. Levels of evidence are provided based on a literature search of relevant publications using the National Library of Medicine, PubMed, and Google Books. Results: Different types of venous pseudoaneurysms, venous aneurysms, and arterial pseudoaneurysm diagnosed by duplex sonography and CT were presented. An extensive historical and literature review was conducted based on publications from the 18th to 21st centuries. Conclusion: Venous pseudoaneurysms are uncommon. Most of them are iatrogenic and are usually found as a complication of repetitive venipuncture in patients receiving hemodialysis with arteriovenous fistulas. In rare cases, venous pseudoaneurysms occur spontaneously. [ABSTRACT FROM AUTHOR]

The highest rate of embolization during carotid artery stenting occurs during post-dilation. We evaluated the ability of the Paladin system (Contego Medical, Raleigh, NC), a novel PTA balloon with an integrated 40-ɥm pore filter, to collect microemboli that may pass into the cerebral circulation when used during post-dilation. 25 symptomatic patients underwent transradial CAS using the Paladin system in conjunction with the Roadsaver (Terumo Corporation, Tokyo, Japan) micromesh stent. No additional embolic protection was used. The Paladin filters were collected following the procedure and preserved in formalin for histological analysis. The contents were evaluated for particle count and size. Subjects were followed for 30 days and evaluated for major cardiac adverse events (death, stroke and MI). Secondary endpoints included procedure success, device success, access site complications according to EASY score classification, major vascular or ischemic complications at follow up and in-stent restenosis rate evaluated with duplex ultrasound. Mean age of patients was 68,5 years. Type 2 aortic arch was present in 77 % of patients and type 1 and type 3 in 12 % and 11 % of patients respectively. Procedural and device success was obtained in all cases without complications. The 30-day MAE rate was 0 %. Twenty-three filters underwent histological analysis. Microscopic debris was present in 100 % of filters, and 75 % of particles were less than 100ɥm in size. The mean number of particles per filter was 3352 ± 1567 (IQR 4300–2343), and the mean number of particles between 40-100ɥm per filter was 2499 ± 1240 (IQR 3227–1575). CAS through radial approach can be safely and effectively performed using the IEP technology Paladin device and double-layer micromesh Roadsaver stent. This strategy can simplify the procedure and decrease peri-procedural complications and procedural time. • Highest rate of embolization during carotid artery stenting occurs during post-dilatation • TRA for CAS offers minimal contact with the aortic arch, reducing the risk of stroke • The Paladin System, further minimizes the risk of cerebral embolization during CAS [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the development of atherosclerosis in ApoE-deficient dogs fed with a high-fat diet (HFD) using vascular duplex ultrasonography (VDU). Methods: Thirty beagle dogs were enrolled, including 10 wild-type, 16 heterozygous (ApoE-/+), and four homozygous (ApoE-/-) mutant dogs. The dogs were categorized into either the normal diet (ND) or HFD group. Plasma lipids levles were tested at baseline and then after feeding the dog a different diet for 6 months. The carotid arteries, abdominal aorta (AO) and iliac arteries were examined using VDU. Artery sections of the ApoE-/- dogs were analyzed. Results: After HFD, lipids especially triglycerides, total cholesterol and low-density lipoprotein (LDL) in the wild type and ApoE-/+ dogs were significantly increased. Both the intima-media thickness (IMT) of the common carotid artery (CCA) and AO in the wild type and ApoE-/+ dogs significantly increased. In the ApoE-/+ dogs, the mean percentages increases in CCAIMT and AO-IMT after HFD were higher than those in the ND dogs. The mean values of CCA-IMT and AO-IMT in the ApoE-/- dogs increased to 2-2.5 folds after HFD. Histological analysis confirmed that the carotid and iliac arteries had advanced atherosclerotic lesions in the ApoE-/- dogs. Conclusions: HFD may accelerate the development of atherosclerosis in ApoE-deficient dogs, which is an optimal large-animal model of atherosclerosis. [ABSTRACT FROM AUTHOR]

Background Although ankle‐brachial index (ABI) and photoplethysmography (PPG) have also shown adequate sensitivity in detecting peripheral arterial disease, their diagnostic performance is less reliable in asymptomatic cases or those with high atherosclerotic cardiovascular risks. Methods and Results We evaluated 130 participants using ABI, PPG, and duplex ultrasonography, diagnosing 65 with peripheral arterial disease. From the PPG, we derived 2 parameters: PPG amplitude ratio of the lower‐to‐upper extremities (PPGratio) and the PPG amplitude of the lower extremity (PPGamp). Sensitivity, specificity, accuracy, and the area under receiver operating characteristic (ROC) curve were calculated for PPG parameters and ABI, and their combination of both methods. Univariate and multivariate logistic regression assessed the prognostic potential of these parameters. ROC analysis revealed optimal cutoff values in diagnosing peripheral arterial disease were 0.417 for PPGratio and “58” for PPGamp. Both PPGratio and PPGamp demonstrated significantly higher sensitivities, 78.4% and 75.7%, respectively, compared with 55.9% for ABI

Background: Von Willebrand factor (VWF) is a large, multimeric glycoprotein that plays a role in thrombus formation; it is also an important mediator of inflammation. Our study aims to determine the association of VWF plasma level and acute ischemic stroke and determine plasma level of VWF in different subtypes of acute ischemic stroke. This case–control study was conducted on 90 subjects: 30 acute ischemic atherosclerotic stroke patients, 30 acute cardioembolic stroke patients and 30 healthy age and sex-matched control subjects. Stroke patients were recruited within the first week of stroke onset with an age range from 18 to 75 years. All subjects underwent complete neurological examination, duplex ultrasonography (U/S), CT brain, routine laboratory work-up and serum level of VWF. Results: VWF serum levels were significantly elevated in patients of acute ischemic stroke, compared to control subjects. Higher plasma levels of VWF were observed in patients with acute ischemic atherosclerotic stroke. Conclusion: Serum level of VWF can be used as a marker for acute ischemic stroke, especially the atherosclerotic subtype. [ABSTRACT FROM AUTHOR]

The expansion of hematopoietic stem cells caused by acquired somatic mutations (clonal hematopoiesis [CH]) is a novel cardiovascular risk factor. The prognostic value of CH in patients with carotid atherosclerosis remains to be evaluated. This study assessed the prognostic significance of CH in patients with atherosclerosis as detected by ultrasound of the carotid artery. We applied deep sequencing of selected genomic regions within the genes DNMT3A , TET2 , ASXL1, and JAK2 to screen for CH in 968 prospectively collected patients with asymptomatic carotid atherosclerosis evaluated by duplex sonography. We detected clonal markers at variant allele frequency ≥2% in 133 (13.7%) of 968 patients (median age 69.2 years), with increasing prevalence at advanced age. Multivariate analyses including age and established cardiovascular risk factors revealed overall presence of CH to be significantly associated with increased risk of cardiovascular death (HR: 1.50; 95% CI: 1.12-2.00; P = 0.007), reflected also at the single gene level. The effect of CH was more pronounced in older patients and independent of the patients' inflammatory status as measured by high-sensitivity C-reactive protein. Simultaneous assessment of CH and degree of carotid stenosis revealed combined effects on cardiovascular mortality, depicted by a superior risk for patients with >50% stenosis and concomitant CH (adjusted HR: 1.60; 95% CI: 1.08-2.38; P = 0.020). CH status in combination with the extent of carotid atherosclerosis jointly predict long-term mortality. Determination of CH can provide additional prognostic information in patients with asymptomatic carotid atherosclerosis. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to analyze cold stimulation‐induced changes in cerebral and cardiac hemodynamics. Methods: Upon ingestion of an ice cube, the changes in resistance index, mean flow velocity and flow index of the middle cerebral arteries (MCA) were assessed using transcranial Doppler sonography. Extracranial duplex sonography was used to measure the mean flow velocity and resistance index of the right internal carotid artery (ICA). The change in mean arterial pressure, heart rate, root mean square of successive differences (RMSSD) and end‐tidal carbon dioxide pressure were analyzed additionally. These changes were compared to sham stimulation. Results: Compared with sham stimulation, cooling of the oral cavity resulted in significant changes in cerebral and cardiac hemodynamics. The cold stimulation decreased the resistance index in the MCA (−4.5% ± 5.4%, p < 0.0001) and right ICA (−6.3% ± 15.6%, p = 0.001). This was accompanied by an increase in mean flow velocity (4.1% ± 8.0%, p < 0.0001) and flow index (10.1% ± 43.6%, p = 0.008) in the MCA. The cardiac effects caused an increase in mean arterial pressure (1.8% ± 11.2%, p = 0.017) and RMSSD (55% ± 112%, p = 0.048), while simultaneously decreasing the heart rate (−4.3% ± 9.6%, p = 0.0001). Conclusion: Cooling of the oral cavity resulted in substantial changes in cerebral and cardiac hemodynamics resulting in a blood flow diversion to the brain. [ABSTRACT FROM AUTHOR]

Aims Trans-radial access (TRA) is the recommended approach for coronary angiography and percutaneous coronary intervention (PCI). Radial artery occlusion (RAO) is the most common complication. We examined the incidence of RAO by means of duplex ultrasonography (DUSG) and the reverse Barbeau test (RBT), after TRA in a clinical setting using conventional pressure dressings to achieve haemostasis. All radial artery patency examinations were performed by one dedicated nurse after a brief training course, we assessed the feasibility and quality of this routine in regular clinical practice. Methods and results In total 97 patients undergoing first-time coronary angiograph and in some cases, PCI via TRA completed the study. Conventional pressure dressing as means of haemostasis was used. Radial artery patency was examined by DUSG and by RBT, before and at follow-up 1 month after the procedure. An inter- and intra-observer validation of the ultrasound measurements was performed before inclusion. Two cases of RAO (2.1%) were discovered following TRA. All RAO cases were detected by both DUSG and the RBT. Results from the inter-observer validation showed no statistically significant discrepancy between an experienced physician and a newly trained nurse operator (P = 0.403). An intraclass correlation coefficient (ICC) was calculated at 0.89 indicating excellent reproducibility. Conclusion In a high-volume TRA centre, we found a low incidence of RAO using conventional pressure dressing as means of haemostasis. The easy-to-use RBT detected all cases of RAO. Following a short course of training, a nurse from the cardiac catheterization laboratory was able to perform high quality DUSG examinations of the radial artery to assess patency. [ABSTRACT FROM AUTHOR]

The article focuses on microsclerotherapy as a treatment for chronic venous disease, particularly addressing technical considerations and management recommendations. Topics discussed include the necessity of duplex ultrasound assessment for symptomatic patients, the use of liquid and foam sclerosants, and post-procedural compression to improve outcomes and reduce complications.

Background: Sparing the Great Saphenous Vein capital for possible arterial substitution and recurrence decrease may be an alternative to current ablation options for Varicose Veins treatment. Conservative surgery of varicose veins (CHIVA) was suggested in 1988 by Franceschi, by limited veins interruptions in strategic points. However, the method did not diffuse due to the need for high Duplex expertise to determine the procedure in every single patient. Method: Evaluation of the literature regarding saphenous sparing, with special reference to CHIVA. Result: It has been realized that basic Ultrasound expertise is sufficient for performing GSV conservation. Most of the time, only a few parameters are needed: a junction competence assessment and a re-entry perforator position. Conclusion: For achieving the goal of saphenous conservative treatment, a limited phlebectomy and possible Junction interruption (crossotomy) may be a simplified solution. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the added value of duplex Doppler examination to the routinely graded compression grayscale ultrasound (US) for patients with suspected acute appendicitis (AA) in correlation with surgical management outcomes. Methods: The study lasted from January 2020 to March 2021. Throughout that period, patients who had suspected appendicitis were included with a visible appendix in the grayscale US. These patients were categorized clinically based on Alvarado's score. They underwent graded compression grayscale US of the appendix and duplex Doppler study. Subsequently, they were assigned for non-contrast multislice computed tomography (MSCT) according to Alvarado's score and underwent either emergency appendicectomy or conservative clinical management afterward. A Student's t-test was used to determine if there were significant differences in the mean values between the groups. The diagnostic performance of spectral Doppler US for the diagnosis of AA was depicted. Results: Eighty-four patients with visualized color flow in the appendicular Doppler US were enrolled, with 60 (71.4%) having AA, and 24 (28.6%) not having appendicitis. Spectral Doppler criterion of PSV greater than 8.6 cm/s demonstrated a high sensitivity of 91.67% and specificity of 77.78% for patients with Alvarado score ranging from 4 to 7, and appendiceal MOD ranging from 6 to 8 mm, while a discriminatory criterion of RI greater than 0.51 had a high sensitivity of 100% and a relatively lower specificity of 66.67%. Conclusion: The patients with AA have significantly higher point PSV and point RI values than those without AA and are especially useful in equivocal patients whose MODs and Alvarado scores are in the diagnostically equivocal ranges of 6–8 mm and 4–7, respectively, with the point PSV and RI demonstrating negative predictive value 87.5% and 100%. [ABSTRACT FROM AUTHOR]

Patients with low-flow, low-gradient aortic valve stenosis constitute a substantial subset of all severe aortic stenosis patients. However, assessment of true severity of these patients can be challenging. In this analysis, we study the utility of the common carotid artery waveforms to distinguish true from pseudo-severe low-flow low-gradient aortic stenosis. This is an observational analysis that included patients who underwent a transthoracic echocardiogram (TTE) and duplex carotid ultrasonography (DCUS) and had low-flow, low-gradient aortic stenosis with reduced left ventricular ejection fraction (LVEF) on the index TTE (LVEF <50%, calculated aortic valve area [AVA] of ≤1.0 cm2, mean and peak gradient of <40 and <64 mm Hg, respectively, and stroke volume index <35 mL/m2). Patients were classified as pseudo-severe and true-severe aortic stenosis based on additional subsequent testing. Differences in various TTE and DCUS waveform parameters across the aortic valve and the common carotid artery were compared between the 2 groups. The study included 30 patients (60 carotid arteries). Fifteen patients were categorized as pseudo-severe and 15 as true severe aortic stenosis. There were no significant differences in calculated AVA, LVEF, stroke volume/stroke volume index, and Doppler Velocity Index in the 2 groups. Mean and peak gradient were higher in patients with true-severe aortic stenosis. Carotid acceleration time (cAT) was significantly prolonged in patients with true-severe compared with pseudo-severe aortic stenosis. A cAT ≥80 ms was 83.3% sensitive and 83.3% specific for true-severe aortic stenosis. cAT acceleration time may be used to distinguish true from pseudo-severe low-flow, low-gradient aortic valve stenosis. [ABSTRACT FROM AUTHOR]

Prior to the curative resection of colorectal carcinoma (CRC) or pancreatic ductal adenocarcinoma (PDAC), the exclusion of hepatic metastasis using cross-sectional imaging is mandatory. The Doppler perfusion index (DPI) of the liver is a promising method for detecting occult liver metastases, but the underlying visceral duplex sonography is critically viewed in terms of its reproducibility. The aim of this study was to investigate systematically the reproducibility of the measured variables, the calculated blood flow, and the DPI. Between February and September 2023, two examinations were performed on 80 subjects within a period of 0–30 days and at two previously defined quality levels, aligned to the German standards of the DEGUM. Correlation analyses were carried out using Pearson's correlation coefficient (PCC) and the intraclass correlation coefficient (ICC). The diameters, blood flow, and DPI showed a high degree of agreement (PCC of 0.9 and ICC of 0.9 for AHP). Provided that a precise standard of procedure is adhered to, the Doppler examination of AHC, AHP, and PV yields very reproducible blood flows and DPI, which is a prerequisite for a comprehensive investigation of its prognostic value for the prediction of metachronous hepatic metastasis in the context of curatively treated CRC or PDAC. [ABSTRACT FROM AUTHOR]

In this study, S32101 duplex stainless steel (DSS) was welded by laser and then subjected to post-weld heat treatment (PWHT) at 1100 °C for various times to tailor the weld microstructure. The impact toughness of the welds was tested at − 40 °C, and the crack propagation behavior was characterized in detail by electron back-scattered diffraction (EBSD). After PWHT for 4.5 and 30 minutes, the austenite volume fraction increases from 17.8 pct (HT0 weld) to 35.4 pct (HT4.5 weld) and 37.7 pct (HT30 weld), and the impact absorbed energies are 4.0, 5.1, and 20.7 J, respectively. Therefore, the austenite volume fraction is not the key factor in determining weld toughness. The increase in austenite in the HT4.5 weld is due to the coarsening of the original austenite, while it is mainly the formation of intragranular austenite (IGA) in the HT30 weld, which contributes to the uniform distribution of austenite. The EBSD analysis shows that the IGA has higher crack propagation resistance than widmanstätten austenite (WA) and grain boundary austenite (GBA) because the crack can deflect at the IGA/ferrite phase boundaries. Coherent or semicoherent orientation relationships (ORs) also increase the fracture critical stress. Therefore, ductile fraction occurs in the HT30 weld, and its toughness improves significantly. In addition, the local plastic deformation caused by IGA agglomeration in the macroscopic cleavage fracture region also enhances the HT30 weld toughness. Thus, the austenite morphology and distribution play a key role in the impact toughness of the welds. [ABSTRACT FROM AUTHOR]

Objectives: Popliteal artery entrapment syndrome (PAES) is a rare condition where musculoskeletal structures compress the popliteal artery (POPA) leading to vascular compromise. This study investigates the effect of dynamic plantar‐ and dorsi‐flexion loading on POPA hemodynamic parameters to develop a robust diagnostic ultrasound‐based protocol for diagnosing functional PAES. Methods: Healthy individuals (n = 20), recreational athletes (n = 20), and symptomatic (n = 20) PAES patients were consented. Triplex ultrasound imaging of lower limb arteries was performed (n = 120 limbs). Proximal and distal POPA's in dorsi‐/plantar‐flexion, in prone and erect positions, were imaged at rest and flexion. Peak systolic velocities (cm/s) and vessel diameter (antero‐posterior, cm) was measured. Results: Distal vessel occlusion was noted across all three groups whilst prone during plantar‐flexion (62.7%). POPA occlusion was only noted in the proximal vessel within the patient group (15.8%). When prone, 50% of control (n = 40 limbs), 70% of athletes (n = 40 limbs), and 65% of patients (n = 40 limbs) had distal POPA occlusion in plantar‐flexion. When prone, recreational athletes (5%), and patients (12.5%) had distal POPA compression under dorsi‐flexion. POPA occlusions with the patient in erect position were only noted in the symptomatic patient group under both dorsi‐flexion (15.8%) and plantar‐flexion (23.7%). Conclusion: Compression of the POPA on ultrasound should not be the sole diagnostic criteria for PAES. POPA compression exists in asymptomatic individuals, primarily under prone plantar‐flexion. To reduce false positives, ultrasound‐based protocols should focus on scanning patients in the erect position only to diagnose PAES, rather than asymptomatic POPA compression. A distinction should be made between the two. [ABSTRACT FROM AUTHOR]

BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is a common disease in the elderly population. OBJECTIVE: The aim was to develop a contrast-enhanced ultrasound (CEUS)-based model for predicting post-angioplasty improvement in hypertension in patients with severe ARAS. METHODS: Thirty-five patients with severe ARAS (⩾ 70%) were included in this study, and 42 renal arteries received percutaneous transluminal renal arterial stenting. An optimal integral formula was developed from pre-interventional color-coded duplex sonography (CCDS) and CEUS parameters using least absolute shrinkage and selection operator (LASSO) regression and receiver operating characteristic (ROC) curve analysis. A model for predicting short-term hypertension improvement was established using the integral formula and clinical risk factors. Bootstrapping was used for internal validation. RESULTS: Two integral formulas, LASSO.CCDS and LASSO.CEUS, were established. ROC curves of the two integral formulas showed that LASSO.CEUS was the better formula for predicting hypertension improvement (AUC 0.816, specificity 78.6%). Univariate and multivariate regression analyses showed that duration of hypertension (OR 0.841, P = 0.027), diabetes (OR = 0.019, P = 0.010), and LASSO.CEUS (OR 7.641, P = 0.052) were predictors of short-term hypertension improvement after interventional therapy. Using LASSO.CEUS combined with clinical risk factors, the following prediction model was established: logit (short-term improvement in hypertension) = 1.879–0.173 × hypertension duration – 3.961 × diabetes + 2.034 × LASSO.CEUS (AUC 0.939). CONCLUSIONS: The model established using CEUS parameters and clinical risk factors could predict hypertension improvement after interventional therapy, but further research and verification are needed. [ABSTRACT FROM AUTHOR]

The American Institute of Ultrasound in Medicine (AIUM) has revised their Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels. This document provides recommendations for the performance and recording of high-quality ultrasound examinations of the kidneys. It includes indications for renal duplex sonography, qualifications and responsibilities of personnel, request and specification for the examination, documentation requirements, equipment specifications, and guidelines for quality and safety. The parameter was developed in collaboration with other organizations and is intended to provide guidance to the medical ultrasound community. [Extracted from the article]

Copyright of Baghdad Science Journal is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality, which is largely attributable to secondary complications such as vasospasm and subsequent delayed cerebral ischemia. Transcranial Doppler (TCD) is recommended for the screening of vasospasm; however, technicians are not always available. We aimed to see how feasible and reliable bedside transcranial point‐of‐care ultrasound (POCUS) color‐coded duplex sonography was compared with formal non‐imaging TCD in measuring velocities and in diagnosing vasospasm. Methods: This was a prospective observational study that took place in the neuroscience intensive care unit at a single academic medical center. Patients with aSAH who were undergoing formal TCDs were scanned on days 2–10 of their admission by physicians of ranging ultrasound experience. Absolute velocities were compared as well as the diagnosis of vasospasm via POCUS and formal TCDs. Results: A total of 226 bedside ultrasound exams were performed and compared with 126 formal TCD studies. Sonographic windows were obtained in 89.4% of patients. Scans took 6.6 minutes to complete on average by the advanced group versus 14.5 minutes in the beginner. Correlation ranged from.52 in the beginner group to.65 in the advanced. When good quality of images obtained at a depth of 4–5 cm were reviewed, correlation of mean velocities increased to.96. Overall sensitivity for diagnosing vasospasm was 75%, with a specificity of 99% and negative predictive value of 99%. Conclusion: Overall, POCUS TCD cannot replace a formal study performed by expert sonographers. An abbreviated POCUS scan can be performed quickly, however, particularly with more experienced operators. POCUS TCD can also feasibly detect vasospasm, and accurate velocities can be obtained by those with all levels of ultrasound experience. Care must be taken on image interpretation that velocities are obtained at an appropriate depth to ensure appropriate insonation of the MCA as well as in optimal alignment with the vessel to obtain the most accurate velocities. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Neuroscience / Ideggyógyászati Szemle is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article discusses the determination of brain death in patients on veno-arterial extracorporeal membrane oxygenation (va-ECMO) using ancillary tests such as electrophysiological methods, transcranial duplex sonography, and brain perfusion scintigraphy. The German Medical Association (GMA) guidelines restrict the use of radiological and perfusion techniques for brain death determination in va-ECMO patients due to a lack of evidence. The article presents a case study where brain death was determined according to the current guidelines and cerebral perfusion was investigated using 99mTc-HMPAO scintigraphy and transcranial duplex sonography. The authors recommend further research to evaluate the use of these methods in diagnosing circulatory arrest in brain dead patients on va-ECMO support. [Extracted from the article]

Introduction: Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors. Methods: All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study. Demographic data, cardiovascular risk factors, aneurysm characteristics, arterial anatomy, repair strategy, systemic and stentgraft-related complications, and in-hospital and late mortality were collected. Routine follow-up included duplex examination and/or CT angiography at 3 months, 12 months and annually thereafter. Logistic regression analysis was performed to detect predictors for SLO. Results: A total of 221 patients (425 stentgraft limbs) were included; of whom 11 patients (5.0%) occluded. Median time to occlusion was 3.3 months and most of the patients presented ischemic signs. Two risk factors for SLO could be identified: symptomatic aneurysm (P.015, odds ratio 4.62, 95% confidence interval 1.35-15.86) and length of the infrarenal abdominal aortic aneurysm (AAA) (P.021, odds ratio 1.31, 95% confidence interval 1.04 - 1.64). Conclusion: The incidence of SLO after EVAR is low, and most occlusions occur within the first year. Predictors for SLO are the symptomatic aneurysm and the length of the infrarenal AAA. Further research is necessary to pool all predictors and to assess the clinical impact of different follow-up strategies for high-vs low-risk patients. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to compare intrarenal arterial Doppler in patients with obstructed and non-obstructed kidneys and to assess the diagnostic value of this procedure in cases of renal obstruction. Methods: This was a hospital-based prospective study conducted among 50 patients with symptoms of acute renal obstruction who attended the Department of Radiodiagnosis at Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, over a period of 18 months from June 2021 to November 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean age of the patients was 36.9 ± 14.2 years. The mean RI value of the right obstructed kidney was 0.74 and the non-obstructed kidney was 0.62, and the left obstructed kidney was 0.74 and the non-obstructed kidney was 0.62. The p-value showed statistical significance. The mean DELTA RI between obstructed and non-obstructed was 0.12. Sensitivity: 96.3%, specificity: 91.3%, positive predictive value: 92.86%, negative predictive value: 95.45%, and diagnostic accuracy: 94%. Conclusion: The Doppler USG has an overall 85% sensitivity and 96.3% specificity in identifying acute renal obstruction when the discriminating threshold value of RI=0.70 is used. The accuracy of ultrasonography in the evaluation can be increased by using renal Doppler recordings, which can demonstrate altered renal perfusion prior to pelvicalyceal system dilatation. This makes Doppler studies a viable diagnostic tool in cases of suspected acute unilateral renal obstruction. For patients who report acute renal colic, Doppler US should thus be used as an adjuvant test in addition to gray-scale sonography. [ABSTRACT FROM AUTHOR]

AIM: First assessment of flow changes in the jugular veins using high resolution ultrasound vector flow. MATERIAL UND METHODS: 15 patients (8 males, 7 females) with an age range of 35 to 82 years (mean age 58.53±12.26 years) were examined by an experienced examiner using high power ultrasound equipment (Resona R9, Mindray) with probe technology (Mindray L9-3U Linear Array transducer, 2.5 to 9.0 MHz). This group was compared with five healthy subjects (mean age 35.4±13.79 years) as a reference. To assess flow changes, the color-coded duplex sonography and the novel vector flow technique were used. The evaluation was performed of vector morphology changes, turbulence, and wall resistance measurements. RESULTS: There were changes after acute and chronic thrombosis in 9 cases, and venous compression in 7 cases. Turbulence was measurable from 0.01 % to 64.44 %, the average turbulence was 19.73±22.06 %. Wall resistance measurement showed values from 0.01 Pa to 3.14 Pa, depending on the age of the thrombosis or compression. The reference veins showed turbulence of 0.94±1.5 % and a mean wall resistance of 0.05±0.05 Pa. There are statistically significant differences between normal and thrombotic or compressed veins in terms of maximum wall stress (p = 0.006) and mean degree of turbulence (p = 0.012), while the difference in mean wall stress is not statistically significant (p = 0.058). CONCLUSION: Despite still existing technical limitations, the combination of V-flow and wall stress measurements in jugular vein changes suggests a high diagnostic potential. [ABSTRACT FROM AUTHOR]

Objectives: The current study aims to investigate the value of penile elastography in assessing the fibrotic changes in the corpora cavernosa. Patients and Methods: Eighty participants were included in the study. These were divided into two equal groups: a study group (group 1) included patients with ED who did not respond to intracavernosal injection (ICI), and an age‐matched control group (group 2) included age‐matched subjects with normal erection. All subjects answered an International Index of Erectile Function‐5 (IIEF‐5) questionnaire. The first group was evaluated by two ICI trials of 1 mL Quadmix, each took place 1 week apart, followed by a color duplex/Doppler ultrasonography (CDDU) scan using also a 1 mL Quadmix. All the above was done a week before the penile shear wave elastography (SWE) scan. It comprised a 12‐section scan of both corpora cavernosa. Each corpus was scanned in three different segments (proximal, mid‐shaft, and distal), and in both longitudinal and transverse axes. Results: Comparisons of the laboratory data were non‐significant, apart from the glycosylated hemoglobin which proved significant (P value <.001) in both groups. Also, the IIEF‐5 scores were significantly lower in the study group (P value <.001). Significantly higher SWE readings (indicating higher fibrotic) were found in the study group compared with the control group in almost all of the scanned segments and their combinations (P value <.05). Conclusion: SWE can effectively assess the fibrotic changes occurring in the corpora cavernosa. Hence, SWE could be utilized as a modality that helps diagnose patients with ED. [ABSTRACT FROM AUTHOR]

Background: Varicose vein is a common surgical disease. Diagnosis and management of the same has significantly improved since the advent of Duplex Ultrasonography. This study was undertaken to evaluate the clinical outcomes in patients with varicose veins treated with Endovenous Laser Ablation (EVLA). Materials and Methods: This retrospective and on-going prospective observational study was carried out in a tertiary care centre for a period of 18 months. Study included total 80 patients who underwent EVLA for varicose veins fulfilling inclusion and exclusion criteria. Demographic data (age, gender), clinical signs and symptoms, USG doppler findings, operative findings, and post-operative complications were recorded. Results: In this study, mean age of study patients was was 44.66 ± 14.33 years with a range from 21 to 69 years, and male preponderance (81.2%). Standing for long duration was reported in 85% of study patients, and in 80% of patient duration of disease was less than from 1 to 5 years. Dilated veins were common clinical presentation seen in 80% patients. In most of patients, hospital stay was ≤4 days. Nerve injury (27.5%) and anesthetic complications (27.5%) were the most common complications seen in this study. Conclusion: EVLA is a safe and reliable minimally invasive procedure to treat varicose vein diseases with minimal post-operative complications. [ABSTRACT FROM AUTHOR]

Background: Deep vein thrombosis (DVT) is a common complication in orthopedic patients. Previous studies have focused on major orthopedic surgery.There are few studies with multiple trauma. We aimed to describe the prevalence of DVT and compare the predictive power of the different risk assessment scales in patients with multiple trauma. Methods: This prospective cohort study involved multiple trauma patients admitted to our hospital between October 2021 and December 2022. Data were prospectively collected for thrombotic risk assessments using the Risk Assessment Profile for thromboembolism(RAPT), the DVT risk assessment score (DRAS), and the Trauma Embolic Scoring System (TESS), respectively. The receiver operation characteristic (ROC) curve and the area under the curve (AUC) were evaluated to compare the predictive power. The whole leg duplex ultrasound of both lower extremities Doppler ultrasound was used to determine DVT incidence. Results: A total of 210 patients were included, and the incidence of DVT was 26.19%. Distal DVT accounted for 87.27%; postoperative DVT, 72.73%; and bilateral lower extremity thrombosis, 30.91%. There were significant differences in age, education degree, pelvic fracture, surgery, ISS, D-dimer level, length of hospital stay and ICU stay between the thrombosis group and the non-thrombosis group. The AUCs for RAPT, DRAS, and TESS were 0.737, 0.710, and 0.683, respectively. There were no significant differences between the three ROC curves. Conclusions: The incidence of DVT was relatively high during hospitalization. We prospectively validated the tests to predict risk of DVT among patients with multiple trauma to help trauma surgeons in the clinical administration of DVT prophylaxis. [ABSTRACT FROM AUTHOR]

Background: It remains unclear whether changes in the venous circulation contribute to cognitive decline. Objective: This study aimed to clarify whether the spontaneous jugular vein reflux (JVR) is associated with cognitive impairment and incident dementia. Methods: Patients with any evidence of cerebral vessel disease on magnetic resonance imaging (MRI) were consecutively enrolled between October 2015 to July 2019. We employed carotid duplex sonography to measure the internal jugular vein (IJV). The subjects were classified into two groups based on the degree of JVR on either side: none, mild (JVR(–) group) and moderate, severe (JVR (+) group) JVR. They underwent both the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Japanese (MoCA-J) global tests. Their cognitive status was prospectively assessed until March 2023. Results: 302 patients with an MMSE score ≥24 underwent duplex sonography of the IJV. Among them, 91 had spontaneous JVR on either side. Both MMSE and MoCA-J were significantly lower in patients with JVR (+) group than in the JVR (–) group. After the adjustment for risk factors and MRI findings, intergroup differences in MoCA-J remained significant. Among the cognitive subdomains, median executive function and memory scores were significantly lower in the JVR (+) group than in the JVR (–) group. During the median 5.2-year follow-up, 11 patients with incident dementia were diagnosed. Patients with severe JVR were significantly more likely to be diagnosed with dementia (log-rank test, p = 0.031). Conclusions: Spontaneous IJV reflux especially severe JVR, was associated with global cognitive function, and potentially with incident dementia. [ABSTRACT FROM AUTHOR]

Non-Hispanic Black (BL) individuals have the highest prevalence of hypertension and cardiovascular disease (CVD) compared with all other racial/ethnic groups. Previous work focused on racial disparities in sympathetic control and blood pressure (BP) regulation between young BL and White (WH) adults, have mainly included men. Herein, we hypothesized that BL women would exhibit augmented resting sympathetic vascular transduction and greater sympathetic and BP reactivity to cold pressor test (CPT) compared with WH women. Twenty-eight young healthy women (BL: n = 14, 22 6 4 yr; WH: n = 14, 22 6 4 yr) participated. Beat-to-beat BP (Finometer), common femoral artery blood flow (duplex Doppler ultrasound), and muscle sympathetic nerve activity (MSNA; microneurography) were continuously recorded. In a subset (BL n = 10, WH n = 11), MSNA and BP were recorded at rest and during a 2-min CPT. Resting sympathetic vascular transduction was quantified as changes in leg vascular conductance (LVC) and mean arterial pressure (MAP) following spontaneous bursts of MSNA using signal averaging. Sympathetic and BP reactivity were quantified as changes in MSNA and MAP during the last minute of CPT. There were no differences in nadir LVC following resting MSNA bursts between BL (-8.70 ± 3.43%) and WH women (-7.30 ± 3.74%; P = 0.394). Likewise, peak increases in MAP following MSNA bursts were not different between groups (BL: þ2.80 ± 1.42 mmHg; vs. WH: þ2.99 ± 1.15 mmHg; P = 0.683). During CPT, increases in MSNA and MAP were also not different between BL and WH women, with similar transduction estimates between groups (ΔMAP/ΔMSNA; P = 0.182). These findings indicate that young, healthy BL women do not exhibit exaggerated sympathetic transduction or augmented sympathetic and BP reactivity during CPT. [ABSTRACT FROM AUTHOR]

We present a case of deep vein thrombosis of the left lower limb secondary to May-Thurner syndrome in a 91-year-old woman. The diagnosis was made by computed tomography, which showed the focal, mildly dilated, distal right common iliac artery with eccentric mural thrombus compressing the proximal left common iliac vein. The patient was treated with oral rivaroxaban and subcutaneous therapeutic low molecular weight heparin. Invasive vascular intervention was deemed to be of limited value, as the patient was minimally symptomatic, of advanced age, with comorbidities, and with features of chronicity of the condition. [ABSTRACT FROM AUTHOR]

Introduction: Recent retrospective cohort study demonstrated the benefit of duplex scanning in the examination of the extracranial carotid artery pathologies for preventing cerebrovascular disorders. The aim of this study: was to evaluate the clinical and demographical characteristics and outcome in patients treated at National Scientific Center of Surgery, after detecting extracranial carotid artery stenosis ≥70%. Material and methods: A retrospective cohort study was conducted; 204 patients were included. Results: The most significant risk factors were: ischemic heart diseases – 95.6%, arterial hypertension – 80.1%, chronic heart failure – 83.8%, cholesterol level above the norm of 5.2 mmol/L-39.2%; 30.4% of patients had a history of postinfarction cardiosclerosis. There were a significant statistically difference between the prevalence of extracranial carotid artery stenosis depending on the risk factors (blood cholesterol levels, a clinical history of chronic heart failure, and acute cerebrovascular diseases p=0.048, p=0.003, p=0.048 respectively (p>0.05)). Conclusion: In summary, we conclude that surgery should be considered, and duplex ultrasound plays a crucial role in assessing the severity of carotid stenosis in atherothrombotic stroke patients with severe external carotid stenosis. These data indicate that physicians, should be aware of the usefulness of carotid duplex ultrasound scanning in stratifying the risk of cerebral and cardiovascular diseases based on various aspects. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the clinical efficacy of a modified surgical procedure for the treatment of varicose veins. Methods: This retrospective analysis was conducted on lower extremities with symptomatic great saphenous vein (GSV) incompetence that underwent stripping from the groin to the knee, with preservation of the superficial epigastric vein (SEV), between January 2015 and April 2022. Follow-up assessments were performed using Doppler ultrasound, Venous Clinical Severity Score (VCSS), and the Aberdeen Varicose Vein Questionnaire (AVVQ) at 6 and 12 months after surgery. Results: The study included 179 limbs from 120 patients (47 men and 73 women). The mean patient age was 56.5 years (range, 20–78 years), and the distribution of preoperative Clinical-Etiology-Anatomy-Pathophysiology clinical classes was 8% C0–C1, 88% C2, and 4% C3–C6. The preoperative diameter of the saphenofemoral confluence averaged 6.9 mm (range, 2.7–15.8 mm). After a mean postoperative follow-up period of 24 months, evidence of neovascularization around the stump of the saphenofemoral junction (SFJ) was observed in 2 limbs (1.1%). Additionally, varicose vein recurrence was found in 1 limb (0.6%) and was associated with an incompetent thigh perforator. At postoperative follow- up, both VCSS and AVVQ scores were significantly lower than the preoperative scores. Conclusion: Modified surgical treatment of GSV incompetence, involving preservation of the SEV and stripping of a short segment up to the knee, demonstrated favorable clinical results in terms of postoperative complication rate, neovascularization rate around the SFJ stump, varicose vein recurrence rate, and improvement in lower extremity symptoms.