The significance of aortoiliac atherosclerosis as assessed by Doppler ultrasound.

A simple, noninvasive method of assessing atherosclerotic aortoiliac obstruction is described using Doppler ultrasound with a concurrent electrocardiogram. The method is significantly more accurate than clinical examination. The pulse wave velocity profile at the common femoral artery is recorded with a nondirectional Doppler probe. The time delay from the R wave of the concurrent electrocardiogram to the ultrasound waveform peak and to a point half-way up the waveform upslope is measured. By evaluating the mean of ten such measurements at each point and then by taking the ratio of the former to the latter, a Proximal Damping Quotient (PDQ) may be derived. If the PDQ is greater than 1.4, significant proximal obstruction is probable. Conversely, a PDQ of less than 1.4 suggests a functionally clear aortoiliac segment. Any patient with a PDQ of less than 1.3 in whom reconstructive surgery is being correlated may thus be spared an aortogram and the affected limb may be investigated by femoral angiography alone. A low PDQ is supporting evidence of an adequate "run-in" to the distal segment when a distal arterial reconstruction is proposed. Similarly, if a femoro-femoral crossover graft is to be used, then significant aortoiliac atherosclerosis proximal to the donor femoral artery may be excluded without recourse to aortography.

Carotid body tumour: 30 years experience.

Thirty-two patients with 37 carotid body tumours, seen in the Vascular Unit at the Royal Victoria Infirmary, Newcastle upon Tyne between 1956 and 1985 are reviewed. Twenty-six of the tumours were treated by surgical excision. There were no peri- or postoperative deaths, but one patient developed a permanent hemiplegia following surgery (3.8 per cent); cranial nerve palsy occurred in five patients (19.2 per cent). There were no malignant tumours although in one patient, histology of the resected specimen showed the presence of local lymph node invasion (3.8 per cent). In the 7 patients who did not undergo surgery, 3 have been lost to follow-up; the remainder have not shown any significant increase in the size of the tumour. One patient was treated by radiotherapy. It is concluded that surgical excision is the treatment of choice, though observation may be preferred for the older patient with a symptomless, slow-growing tumour. To help reduce the risk of hemiplegia (the most serious complication of surgery) a meticulous surgical technique is necessary and heparin, intraluminal shunting and facilities for arterial repair and grafting must be at hand.