Measurement of carotid artery stenosis: correlation analysis between B-mode ultrasonography and contrast arteriography / 대한외과학회지

PURPOSE: To evaluate the efficacy of B-mode ultrasonography (US) in measurement of carotid stenosis% (CS%). METHODS: One hundred and thirth-three carotid arteries in 96 patients who underwent both carotid US and carotid arteriography (CA) were included in this retrospective study. To measure CS% on US, a cross sectional view of the most stenotic segment of the internal carotid artery was captured and residual diameter and original diameter of that segment were measured with electronic caliper on the same plane and in the same direction. To measure CS% on an angiogram, we used European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) methods. Pearson's correlation analysis and linear regression analysis were used to determine the correlation between CS% on an US and angiogram. RESULTS: Pearson's correlation coefficient (R) between CS% measured in US and CA were 0.853 (ECST method, P < 0.001) and 0.828 (NASCET method, P < 0.001). Accuracies of B-mode US were 93.2%, 88.0%, and 81.2% for estimating CS% by ECST method and 86.5%, 82.7%, and 82% for estimating CS% by NASCET method. CONCLUSION: CS% measured in B-mode US was simpler and showed a strong positive correlation with that measured on an arteriogram either ECST or NASCET method.

Prevalence of Asymptomatic Critical Carotid Artery Stenosis in Korean Patients with Chronic Atherosclerotic Lower Extremity Ischemia: Is a Screening Carotid Duplex Ultrasonography Worthwhile?

This study aimed to investigate prevalence of asymptomatic carotid artery stenosis (ACAS) in Korean patients with peripheral arterial disease (PAD) and identify predictive factors of ACAS in patients with PAD. Between 1994 and 2008, 546 patients who underwent bypass surgery due to PAD were identified in a single tertiary teaching hospital. Of those, 409 patients underwent preoperative screening carotid duplex ultrasonography (CDUS). Patients who had an episode of cerebrovascular event or previous carotid artery intervention were excluded and then a retrospective analysis was made of 340 patients. The degree of internal carotid artery (ICA) stenosis was determined by the criteria of Society of Radiologists in Ultrasound Consensus Conference. To determine the risk factors of ACAS, demographic, coexisting medical condition and lesion characteristics were tested with binary logistic regression model. The prevalence of > or =70% ICA stenosis was 14%. ICA occlusion was detected in 7.1%. Multivariate analysis revealed age >65 yr (OR: 2.610, 95% CI: 1.197-5.691) and coronary artery disease (CAD, OR: 2.333, 95% CI: 1.169-4.657) are predictive factors of > or =70% stenosis. A PAD patient who needs revascularization, particularly, >65 yr or has a concomitant CAD, can be a good candidate of screening CDUS.

Splenic Artery Aneurysms: Ten Years of Experience

PURPOSE: Splenic artery aneurysms (SAAs) are rare but have the potential risk of life threatening rupture. We conducted this study to define the natural history of SAAs and to compare the results of surgery and endovascular treatment for SAAs. METHODS: From July 2001 to August 2010, 23 patients were treated for SAAs in a single institution. A retrospective study was performed on these patients. RESULTS: No cases of rupture or mortality occurred during follow-up. Nine patients were observed without any intervention, and growth of an aneurysm was detected in only two patients with a mean growth rate of 0.02 cm/yr. Ten patients underwent open surgery and four underwent endovascular treatment. The indications for treatment were an aneurysm larger than 2 cm in nine patients, a symptomatic aneurysm in one patient, one enlarging aneurysm, one reproductive-age female, and aneurysm exclusion was performed during abdominal aortic aneurysm repair in one patient. In the treatment group, no case of recurrence of an aneurysm or restoration of blood flow was observed. Postembolization syndrome and a partial splenic infarct occurred in one patient who underwent endovascular exclusion for an aneurysm. CONCLUSION: Both open surgery and endovascular treatment are safe and effective treatment modalities for SAA with a low risk of complications or mortality. However, conservative management is another treatment option that should be considered for patients with a low risk of rupture.