[Diagnosis of varicose disease]. / Diagnostic de la maladie variqueuse.

DIAGNOSIS OF VARICOSE DISEASE. Varicose vein disease corresponds anatomically to an alteration of the venous wall and/or the valve system of one or more superficial veins, or segments of these veins, and is characterized by reflux causing venous hypertension. The clinical signs, precisely described by the CEAP classification (clinical, etiological, anatomical, pathophysiological), include aside asymptomatic forms, telangiectasias, varicose veins, edema, and skin disorders up to the stage of leg ulcers. The functional signs, also very variable and sometimes absent, are not limited to leg heaviness. Non-specific, they are mainly characterized by their timing and mode of occurrence. Duplex ultrasound (DU) examination allows to confirm the existence of venous reflux, to specify its extension, to measure the diameter of the pathological veins and to analyze their wall remodeling. DU is essential to precisely characterize the varicose disease to define the therapeutic modalities to be considered. Its results are recorded on a venous cartography which graphically represents all the echo-anatomical and hemodynamic data collected. In the event of varicose disease, a specialized medical consultation is necessary to offer therapeutic care adapted to the specific problem of each patient.

DIAGNOSTIC DE LA MALADIE VARIQUEUSE. La maladie variqueuse correspond anatomiquement à une altération de la paroi veineuse et/ou du système valvulaire d'une ou plusieurs veines superficielles ou de certains segments de ces veines et se caractérise par un reflux à l'origine d'une hypertension veineuse. Sa présentation clinique très variée, bien décrite par la classification CEAP (clinique, étiologique, anatomique, physiopathologique), inclut, outre les formes asymptomatiques, des télangiectasies, des varices, un œdème et des troubles trophiques cutanés jusqu'au stade des ulcères de jambe. Les signes fonctionnels, très variables eux aussi et parfois absents, ne se limitent pas aux seules lourdeurs de jambe. Non spécifiques, ils sont principalement caractérisés par leur horaire et leur mode de survenue. L'écho-Doppler permet d'affirmer l'existence d'un reflux veineux, d'en préciser l'extension, de mesurer le diamètre des veines pathologiques et d'analyser leur paroi. L'écho-Doppler est indispensable pour caractériser précisément la maladie variqueuse et pour définir les modalités thérapeutiques à envisager. Ses résultats sont consignés sur une cartographie veineuse qui représente de façon graphique toutes les données écho-anatomiques et hémodynamiques recueillies. En cas de maladie variqueuse, un avis spécialisé est nécessaire pour proposer une prise en charge thérapeutique adaptée à la problématique spécifique de chaque patient.

Current Diagnostic and Therapeutic Challenges in Superficial Venous Thrombosis.

Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). SVT shares similar risk factors with DVT and is frequently associated with the presence of varicose veins. However, the occurrence of non-varicose veins could conceal risk factors such as malignancies, thrombophilia, or Buerger's disease. While the clinical diagnosis is generally straightforward, additional diagnostic evaluations are often necessary. Duplex ultrasound (DUS) is an invaluable tool that provides the location of SVT, the proximity to the sapheno-femoral junction, and the clot length, all of which influence the decision for optimal management. The treatment of SVT should be symptomatic, pathogenic (limiting the extension of thrombosis), and prognostic (to prevent complications). There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications.

Diagnostic Potential of Combined Photoplethysmography and Ankle-Brachial Index in Peripheral Arterial Disease: A Duplex Ultrasonography-Based Comparative Study.

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 <0.9 (P<0.05). The areas under the ROC curves of combination models, including model 1 (ABI <0.9 and PPGratio), model 2 (ABI <0.9 and PPGamp), and model 3 (ABI <0.9, PPGratio, and PPGamp), exhibited improved performance with areas under the ROC curves of 0.922, 0.922, and 0.931 (all P<0.01) compared with ABI alone (area under the ROC curve, 0.822). Additionally, the PPG parameters, both alone and combined with ABI, were associated with major adverse cardiac events and all-cause mortality after adjusting for other relevant factors. CONCLUSIONS: On the basis of duplex ultrasonography, combining ABI and PPG markedly improves peripheral arterial disease diagnosis in high-risk individuals compared with either method alone and provides crucial insights into major adverse cardiac events and all-cause mortality risks.

I saw the "hook" sign of median arcuate ligament syndrome.

The hook sign is a radiologic finding best appreciated on a sagittal view of the celiac artery with computed tomography (CT) that indicates compression of the celiac artery. It refers to the hooked-shape of the proximal celiac artery caused by extrinsic compression by the median arcuate ligament. When seen in a patient with concurrent abdominal symptoms, it suggests median arcuate ligament syndrome (MALS). We saw the sign in a 15-year-old male via duplex ultrasonography and abdominal CT. He underwent laparoscopic release of the median arcuate ligament and had full resolution of his symptoms at follow-up.

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis.

INTRODUCTION: Internal carotid artery (ICA) stenosis causes about 15% of ischemic strokes. Duplex ultrasonography (DUS) is the first line of investigation of ICA stenosis, but its accuracy varies in the literature and it is usual to complement the study with another more accurate exam when faced with significant stenosis. There is a lack of studies that compare DUS with angiotomography (CTA) in the present literature. METHODS: we performed an accuracy study, which compared DUS to CTA of patients in a tertiary hospital with a maximum interval of three months between tests. Patients were selected retrospectively, and two independent and certified vascular surgeons evaluated each image in a masked manner. When there was discordance, a third evaluator was summoned. We evaluated the diagnostic accuracy of ICA stenosis of 50-94% and 70-94%. RESULTS: we included 45 patients and 84 arteries after inclusion and exclusion criteria applied. For the 50-94% stenosis range, DUS accuracy was 69%, sensitivity 89%, and specificity 63%. For the 70-94% stenosis range, DUS accuracy was 84%, sensitivity 61%, and specificity 93%. There was discordance between CTA evaluators with a change from clinical to surgical management in at least 37.5% of the conflicting reports. CONCLUSION: DUS had an accuracy of 69% for stenoses of 50-94% and 84% for stenoses of 70-94% of the ICA. The CTA analysis depended directly on the evaluator with a change in clinical conduct in more than 37% of cases.

[Role of duplex ultrasonography of the ophthalmic artery in internal carotid artery stenosis]. / Die Rolle der Duplexsonographie der Arteria ophthalmica bei Stenosen der Arteria carotis interna.

BACKGROUND: Duplex sonographic visualization of a retrogradely perfused ophthalmic artery (AO) as an expression of an existing collateral supply in high-grade stenosis of the internal carotid artery (ACI) is a widely used and validated tool. After revascularization there may be another reversal of flow. Recently, the question of whether knowledge of the flow direction of the AO before and after implantation of a stent can be used as an outcome predictor has been posed more frequently. METHODS AND RESULTS: In this article, the method of duplex sonographic assessment of the AO is explained more elaborately and we present a case of a patient with 75% restenosis of the left ACI with contralateral chronic occlusion of the right ACI. We focus on the special aspect that the ipsilateral AO was initially perfused retrogradely and that postinterventionally there was a flow reversal to a physiological anterograde flow. The case report is used to illustrate the value of duplex sonographic visualization of the AO. CONCLUSION: Our case report is able to illustrate two aspects: On the one hand, the AO can be perfused retrogradely in the specific case of chronic ACI occlusion of the opposite side, even when the ACI stenosis of the considered side is less than 80%. On the other hand, the AO can offer added diagnostic value as a follow-up parameter for re- or in-stent stenoses.

Should all critical care patients with a central venous catheter in situ be screened for central catheter related thrombosis?

There are many studies on central catheter related thrombosis (CCRT), however, there are significantly fewer studies focusing on the incidence and evolution of CCRT in the adult critical care population. This article reviews data collected from observational studies that have performed bedside duplex ultrasound for surveillance of CCRT and discuss if we should routinely screen for CCRT. The reported CCRT incidence is 17-38%, with most thrombus being detectable on ultrasound within seven days of line placement. Nearly all CCRT are designated as asymptomatic (no associated pulmonary embolism (PE) or deep vein thrombosis (DVT)) and no significant changes in mortality rates amongst patients that develop CCRT were reported. Based on the evidence reviewed, we do not recommend screening routinely for CCRT in the adult critical care population.

Effectiveness of contrast-enhanced duplex ultrasound for detecting renal artery stenosis: A systematic review.

PURPOSE: Contrast-enhanced duplex ultrasound (CEUS) might be a useful tool to diagnosing renal artery stenosis (RAS). We amalgamated and reviewed the evidence assessing the diagnostic accuracy of CEUS on detecting RAS compared to angiography. METHODS: This preregistered systematic review included studies that compared the presence of RAS via CEUS with angiography. Sources were searched in November 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier (n = 1717). The Quality Assessment of Diagnostic Studies 2 tool assessed study quality. Results are presented narratively. RESULTS: The studies included (n = 11) had a total of 447 unique participants (193 females) and average age of 56 ± 9 years. Five of eleven studies investigated CEUS using SonoVue contrast agent and reported an average accuracy (91% ± 2%), sensitivity (91% ± 3%), specificity (90% ± 5%), negative predictive value (86% ± 6%), and positive predictive value (94% ± 1%) with all values >80%. The accuracy of CEUS using other types of contrast agent (n = 6), including Levovsit (n = 3/6), Definity (n = 1/6), perfienapent emulsion (n = 1/6), and perfluorocarbon-exposed sonicated dextrose albumin (n = 1/6) was mixed. These studies detected an average accuracy of 91 ± 11% (n = 2/3% > 80%), sensitivity of 98% ± 4%, (n = 3/3% > 80%), and specificity of 86% ± 10% (n = 2/3% > 80%). Included studies had generally low risk of bias and applicability concerns except for unclear flow and timing (n = 7/11) and applicability of patient selection (n = 4/11). CONCLUSION: Despite being limited by the heterogeneity of included studies, our review indicates a high overall diagnostic accuracy for CEUS to detect RAS compared to angiography, with the largest evidence-base for SonoVue contrast. Radiologists and hospital decision makers should consider CEUS as an acceptable alternative to angiography.

Role of Carotid Ultrasonography Combined with Monocyte/HDL Ratio in Internal Carotid Artery Stenosis.

BACKGROUND: Carotid duplex ultrasonography (DUS) is the primary screening tool for carotid artery stenosis, but has low reliability. MHR, which is the ratio of monocytes to high-density lipoprotein cholesterol (HDL-C), can be a marker for the degree and distribution of extracranial and intracranial atherosclerotic stenosis. OBJECTIVE: We determined the diagnostic value of DUS+MHR for internal carotid artery (ICA) stenosis. METHODS: We divided 273 hospitalized patients into non-stenosis (<50%) and ICA stenosis (≥50%) groups based on Digital Subtraction Angiography (DSA). We determined the peak systolic velocity (PSV) in the ICA on DUS, calculated the MHR, and investigated their relationship with ICA stenosis. RESULTS: On DSA, 34.1% (93/273) patients had moderate-to-severe ICA stenosis. DUS and DSA showed low concordance for detecting ICA stenosis (kappa = 0.390). With increasing age, the incidence of moderate-to-severe ICA stenosis increased. PSV, monocyte count, and MHR were significantly greater in the stenosis group than in the non-stenosis group (P < 0.001), while the HDL-C level was significantly lower (P = 0.001). PSV (OR: 1.020, 95% CI: 1.011-1.029, P < 0.001) and MHR (OR: 5.662, 95% CI: 1.945-16.482, P = 0.002) were independent risk factors for ICA stenosis. The area under the receiver operating characteristic curve of PSV+MHR (0.819) was significantly higher than that of PSV or MHR alone (77.42% sensitivity, P = 0.0207; 73.89% specificity, P = 0.0032). CONCLUSION: The combination of ICA PSV on DUS and MHR is better than PSV alone at identifying ICA stenosis and is well-suited to screen high-risk patients.

Quality of referrals for lower extremity ultrasonography and computed tomography pulmonary angiography and associations with positive findings of venous thromboembolism.

INTRODUCTION: The referral is the basis for radiologists' assessment of modality, protocol and urgency, and insufficient information may threaten patient safety. The aim of this study was to assess the completeness of referrals for lower extremity venous duplex ultrasonography (LEVDUS) and computed tomography pulmonary angiography (CTPA), and to investigate associations between the provided clinical information including risk factors, symptoms and lab results in the referrals and positive findings of deep vein thrombosis (DVT) and pulmonary embolism (PE), respectively. METHODS: Referrals for LEVDUS (801) and CTPA (800) performed from 2016 to 2019 were obtained. Three categories of clinical information from the referrals were recorded: symptoms, risk factors and laboratory results, as well as positive imaging findings of venous thromboembolism (VTE). Referral completeness was rated from zero to three according to how many categories of clinical information the referral provided. RESULTS: Information from all three clinical information categories was provided in 15% and 25% of referrals for LEVDUS and CTPA, respectively, while 2% and 10% of referrals did not contain any clinical information. Symptoms were provided most often (85% for LEVDUS and 94% for CTPA). Provided information about risk factors was significantly associated with positive findings for LEVDUS, (p = 0.02) and CTPA (p < 0.001). CONCLUSION: A great majority of referrals failed to provide one or more categories of clinical information. Risk factors were associated with a positive finding of VTE on LEVDUS and CTPA. IMPLICATIONS FOR PRACTICE: Improving clinical information in referrals may improve justification, patient safety and quality of radiology services.

A comprehensive ultrasound approach to lower limb varicose veins and abdominal-pelvic connections.

OBJECTIVE: Pelvic venous reflux may be responsible for pelvic venous disorders and/or lower-limb (LL) varicose veins. Ultrasound investigation with Doppler allows a complete study of the entire infra-diaphragmatic venous reservoir. The aim of this study was to guide and standardize the investigation of the pelvic origin of venous reflux in female patients with LL varicose veins. METHODS: In this case-control study, we applied a comprehensive ultrasound investigation protocol, which involved four steps: (1) venous mapping of the lower limbs; (2) transperineal and vulvar approach; (3) transabdominal approach; and (4) transvaginal approach. RESULTS: Forty-four patients in group 1 (patients with LL varicose veins and pelvic escape points [PEPs]) and 35 patients in group 2 (patients with LL varicose veins without PEPs [control group]) were studied, matched by age. The median age was 43 years in both groups. The calculated body mass index was lower in group 1 (23.4 kg/m2) compared with the control group (25.4 kg/m2), and this difference reached statistical significance (P < .001). The presence of pelvic varicose veins (PVs) by transvaginal ultrasound was 86% in group 1 and 31% in group 2. Perineal PEPs were the most prevalent, being found in 35 patients (79.5%), more frequent on the right (57.14%) than on the left (42.85%) and associated with bilateral PVs 65.7% of the time. In group 1, 23 patients (52%) reported recurrent varicose veins vs eight patients (23%) in the control group (P = .008). Regarding the complaint of dyspareunia, a significant difference was identified between the groups (P = .019), being reported in 10 (23%) patients in group 1 vs one patient (2.9%) in the control group. The median diameters in the transabdominal approach of the left gonadal veins were 6.70 mm for group 1 and 4.60 mm for group 2 (P < .001). In patients with PVs in group 1, the median diameter of PEPs at the trans-perineal window was 4.05 mm. In the transvaginal examination, the mean diameter of the veins in the peri uterine region was 8.71 mm on the left and 7.04 mm on the right. CONCLUSIONS: The identification of PEPs by venous mapping demonstrates the pelvic origin of the reflux and its connections with the LL varicose veins. For a more adequate treatment plan, we suggest a complete investigation protocol based on the transabdominal and transvaginal study to rule out venous obstructions, thrombotic or not, and confirm the presence of varicose veins in the pelvic adnexal region.

A rare hemodialysis vascular access complication-Internal jugular vein reflux.

Hemodialysis (HD) arteriovenous fistulas commonly present with late vascular access complications, but are rarely in association with internal jugular vein (IJV) reflux. We reported two patients who had severe and mild IJV reflux, respectively. Case 1 was a 48-year-old male with end-stage renal disease (ESRD) who had been treated with HD for 5 years. He presented with persistent headaches, nausea, and vomiting. Combined with all the examinations, it was revealed severe IJV reflux, brachiocephalic vein stenosis, high-flow vascular access, and IJV valve dysfunction. Case 2 was a 59-year-old female with ESRD who had constructed an AVF for 4 months and had been on HD for only 1 day. She presented with dizziness and nausea after the first hemodialysis and duplex ultrasonography showed slightly continuous IJV reflux, high-flow vascular access, and IJV valve dysfunction. Furthermore, we reviewed 16 case reports to identify the characteristics of IJV reflux in HD patients. IJV reflux in HD patients may be caused by high-flow access, central venous stenosis or occlusion, and valve dysfunction. Severe IJV reflux can develop neurological symptoms secondary to intracranial venous reflux in this article. Etiological treatment is helpful for these patients, but there is a risk of recurrence.

The Effect of Ipsilateral Carotid Revascularization on Contralateral Carotid Duplex Parameters in Patients with Bilateral Carotid Stenosis.

BACKGROUND: Duplex-derived velocity measurements are often used to determine the need for carotid revascularization. There is evidence that severe ipsilateral carotid stenosis can cause artificially elevated velocities in the contralateral carotid artery, which may decrease following ipsilateral revascularization. The objective of this study was to determine if contralateral carotid artery duplex velocities decrease following ipsilateral carotid endarterectomy or stenting procedures. METHODS: This is a single institutional retrospective study of prospectively collected data on all patients who underwent carotid revascularization from 2013 to 2021. Patients with immediate preoperative and first postoperative Duplex scan within 4 months of carotid revascularization at our vascular laboratory were included for analysis. Patients with contralateral occlusion were excluded. Duplex criteria used to define moderate (50-69%) and severe (>70%) stenosis were systolic velocity ≥125 cm/sec and ≥230 cm/sec, respectively. RESULTS: Between 2013 and 2021, 129 patients with bilateral carotid stenosis underwent either carotid endarterectomy (98) or a stenting procedure (31). The majority of patients (90%) underwent intervention for severe stenosis. Preoperatively, the contralateral artery was categorized as severe in 30.4% patients. After ipsilateral carotid revascularization, 86 patients (67.2%) saw a decrease in the contralateral artery peak systolic velocity (PSV), while the remaining remained stable or increased. Fifty-four patients had a change in designated stenosis severity in the contralateral artery. Between the carotid endarterectomy and stenting cohorts, there was no significant difference in the proportion of patients whose contralateral velocity decreased (69.4% vs. 61.3%, P = 0.402). Patients with coronary artery disease and diabetes were significantly less likely to experience a decrease in the contralateral artery PSV after ipsilateral intervention (P = 0.018 and P = 0.033). CONCLUSIONS: In patients with bilateral carotid disease, ipsilateral revascularization can change the contralateral artery velocity and perceived disease severity. Most patients were noted to have a decrease in the contralateral artery PSV, although almost one-third either stayed stable or increased. On multivariable analysis, patients with coronary artery disease and diabetes were less likely to see a decrease in the contralateral artery PSV after intervention. Patients who are at risk for artificial elevation of the contralateral artery may warrant a re-evaluation of the contralateral artery after ipsilateral intervention. These patients are potentially better assessed with axial imaging, although further research is needed.

Standardized Methodology for Duplex Ultrasound Examination of Arteriovenous Access for Hemodialysis: A Proposal of the French Society of Vascular Medicine and the French-Speaking Society of Vascular Access.

Duplex ultrasound (DUS) is an essential tool for characterizing and monitoring arteriovenous (AV) access for hemodialysis. The aim of the work described here, requested by the French Society of Vascular Medicine in collaboration with the French-Speaking Vascular Access Society, is to propose a standardized methodology for performing and documenting DUS, taking into account the variety of AV access techniques and the problems routinely encountered. A steering committee reviewed the literature and selected the relevant references. A draft was prepared, and all items with missing or conflicting data were submitted to a Delphi consensus. The final document was discussed and approved by all participants. The principles of DUS evaluation of AV access consist of examination of the afferent artery, the anastomosis and the entire venous drainage system. DUS uses B-mode ultrasound, color flow, pulsed wave and power Doppler analysis. DUS can be used in a variety of clinical situations, which can directly influence the methodology of the examination and the interpretation of the results. Blood flow should be assessed as it correlates with the risk of thrombosis. The measurement should be adapted to the different anatomical and hemodynamic conditions encountered. Characterization of stenosis should take into account the residual diameter of the drainage vein and its hemodynamic consequences. Other complications can be assessed with a standardized DUS examination. When performed according to a rigorous methodology, DUS of the AV access allows a comprehensive assessment of its functionality and eliminates the need for further invasive diagnostic procedures.

Mesenteric and renal arterial duplex ultrasound: A review.

Duplex ultrasound examinations of the mesenteric and renal circulations are commonly used to detect disease as well as to follow up patients after open surgery or endovascular intervention. The aims of this review were to present essential elements of these duplex ultrasound examinations as well as conduct a literature review of diagnostic criteria. Documentation of appropriate images and data will aid in an accurate interpretation. Spectral Doppler waveforms from various segments of these arterial systems can contribute both direct and indirect evidence of the presence of disease. Various studies have validated the duplex ultrasound diagnostic criteria which more recently have expanded to include specific criteria for stented vessels. This review presents a summary of the fundamental exam components and diagnostic criteria utilized for mesenteric and renal duplex ultrasound.

Effect of anterior communicating artery patency on the flow velocity in bilateral carotid artery stenosis after carotid endarterectomy.

BACKGROUND: The effect of anterior communicating artery (ACoA) patency on the flow velocity of the extracranial carotid arteries is unclear. METHODS: A total of 285 patients with carotid artery stenosis were included between January 2019 and January 2021. All patients received unilateral carotid endarterectomy (CEA). The patients were classified into ACoA-patent (161) and ACoA-nonpatent (124) groups using digital subtraction angiography (DSA) and/or computed tomography angiography (CTA). The peak systolic velocity (PSV) and end-diastolic velocity (EDV) measured by carotid duplex ultrasonography (CDU) were compared between both groups, pre- and post-CEA. RESULTS: There was no significant difference in the risk factors for cerebrovascular disease between the two groups. Within 1 week after CEA, the PSV and EDV on operative and nonoperative carotid (contralateral carotid in the same patient) arteries decreased significantly (both p < 0.01). Comparison of nonoperative carotid artery pre- and post-CEA between the two groups showed that post-CEA PSV and EDV in the ACoA-patent group were significantly lower than that of pre-CEA (PSV and EDV, t = 11.507 and 6.716, respectively, both p < 0.001) (according to the Society of Radiologists in Ultrasound Consensus Conference [SRUCC] PSV standard). There was no significant difference in the ACoA-nonpatent group (PSV: t = 1.924, p = 0.057; EDV: t = 1.237, p = 0.218). In the nonoperative carotid artery of the ACoA-patent group, the degree of stenosis assessed by CDU was inconsistent with that of DSA/CTA (κ = 0.294), whereas that in the ACoA-nonpatent group had a high consistency (κ = 0.982). Among 161 ACoA-patent cases, 68 showed overestimated stenosis. CONCLUSIONS: The patent ACoA increases PSV and EDV, causing an overestimation of carotid artery stenosis.

The First Latin American Consensus on Superficial and Perforating Venous Mapping.

With the aim of obtaining a map which is useful as a diagnostic tool and therapeutical orientation, complementing the written report of duplex ultrasound venous study, Latin-American Scientific Societies of Phlebology, Vascular Surgery and Vascular Imaging were invited to participate, through their regional representatives, to the First Consensus of Superficial and Perforating Venous Mapping. A consensus process using a modified Delphi method was carried out. An International Working Group was formed, which developed a Prototype of the Venous Mapping that worked as a starting point for consensus, and was presented in a first virtual meeting of 54 experts (societies' representatives) when the methodology was explained. For the consensus process, two rounds of self-administrated questionnaires with feedback were used. In the first questionnaire a 100% consensus was obtained in the 15 statements (an agreement range of 85.2% to 100%) In the analysis of qualitative data, three categories according to the actions to implement were identified - actions which involved no action, minor changes and major changes. This analysis was used to build the second questionnaire, which reached a consensus in its six statements (agreement range of 87.1% to 98.1%). A final consensus on every field proposed was established with the approval of all the experts consulted and it was presented at a third online meeting. The document of the superficial and perforating venous mapping reached by consensus is presented hereafter.

Accuracy of the Society of Radiologists in Ultrasound (SRU) Carotid Doppler Velocity Criteria for Grading North American Symptomatic Carotid Endarterectomy Trial (NASCET) Stenosis: A Meta-Analysis.

PURPOSE: The Society of Radiologists in Ultrasound (SRU) consensus panel proposed six Doppler velocity cut points for classifying internal carotid artery (ICA) stenosis of 50% and 70% according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. Their relative accuracies have not been compared. MATERIALS AND METHODS: Meta-analysis performed following comprehensive literature review and identification of manuscripts with graphs of individual patient NASCET ICA stenosis measured by arteriography versus ICA peak-systolic velocity (PSV), end-diastolic velocity (EDV) and ICA PSV to common carotid artery (CCA) PSV. True positives, true negatives, false positives, and false negatives were calculated and used in two-level mixed effects models. Hierarchical summary receiver operating characteristic (ROC) curves were generated. Areas under the ROC curves were estimated. RESULTS: Nine studies performed between 1993 and 2016 were identified after review of 337 manuscripts. There were 1738 bifurcation data points extracted for PSV, 1026 for EDV, and 775 for ICA/CCA ratio. The highest sensitivity was 96% (95% CI: 93%, 98%) for PSV of 125 cm/s (50% stenosis) and highest specificity 86% (95% CI: 71%, 93%) for PSV of 230 cm/s (70% stenosis). Areas under the ROC curves ranged from a high of 0.93 (95% CI: 0.92, 0.95) for PSV (50% stenosis) to a low of 0.86 (95% CI: 0.84, 0.88) for EDV (70% stenosis). CONCLUSIONS: The SRU consensus Doppler cut points vary in their accuracies for predicting ICA stenosis. The PSV cut points have tradeoffs: high sensitivity/low specificity for 50% stenosis and high specificity/moderate sensitivity for 70% stenosis.

An unusual cause of failure in Zenith Alpha Abdominal endograft.

BACKGROUND: Graft disruption is an unusual complication of the endovascular abdominal aortic aneurysm repair (EVAR). CASE PRESENTATION: A 71-year-old man underwent standard EVAR with Zenith Alpha Abdominal endograft. Follow-up examinations revealed an initial significant sac shrinkage. At 24 months, duplex ultrasound (DUS) scan and computed tomography showed increase of the sac diameter associated with complete disconnection of the suprarenal stent-graft from the main body without evidence of endoleak. A standard relining with a thoracic endograft was performed between the suprarenal stent and the main body of the previous graft. At 6 months DUS revealed sac shrinkage. CONCLUSIONS: This report demonstrates an uncommon cause of endograft failure with suprarenal stent disconnection from main body and highlights the need for continuous follow-up in patients undergoing EVAR.

Gender differences in the detection of carotid atherosclerosis: DUPLEX registry cross-sectional study results.

The aim of this study was to assess the features of detecting carotid atherosclerosis depending on gender, age, the presence of arterial hypertension, other major diseases and conditions according to  The Duplex Registry Database. The registry sequentially included the results of duplex scanning of the carotid arteries (DSCA) of all patients who underwent it at the United Hospital with Outpatient Department in 2013 (n=2548). The incidence of carotid atherosclerosis (CAS) was higher in men than in women (58.6% (n=763) vs 45.5% (n=568), p<0.0000001). This was noted in all categories according to the gradation of stenosis, including in the category of the most severe lesion (>70%): 2.9% (n=32) vs 1.0% (n=13), p=0.003. The presence of CAD significantly increased the chances of detecting CAS in men (OR 4.47 vs 2.6, p<0.0000001). Signs more significant in their influence in women compared to men were the following: age (OR 5.3 [4.12; 6.71] p<0.0000001); arterial hypertension (OR 2.7 [2.12; 3.39] p<0.0000001) and cerebrovascular disease (OR 1.63 [1.13; 2.36] p=0.004). The OR of CAS detection for the "acute cerebrovascular accident" diagnosis in men and women differed 2 times (OR 1.2, p=0.4 vs 2.4, p=0.15). The "hypercholesterolemia" diagnosis when referred for DSCA did not show itself as a predictor of CAS detection in all study groups. Disorders of autonomic nervous system, hearing loss and screening examination showed a significant decrease in the probability of CAS detecting for the whole group (OR 0.14 [0.08;0.24] p<0.0000001; OR 0.16 [0.02;0.66] p=0.004 and OR 0.3 [0.25 0.37] p<0.0000001, respectively), so and separately for males and females. The present study revealed significant gender differences in the prevalence of carotid atherosclerosis and in the influence of various signs on an increase in the chances of its detection. The most significant signs were (OR men vs women): gender (1.3 vs 0.8), age (4.2 vs 5.3), arterial hypertension (1.8 vs 2.7), CAD (4.4 vs 2.6), cerebrovascular disease (1.26 vs 1.63).