Venous duplex ultrasound protocol for iliocaval disease.

Venous duplex ultrasound imaging of the retroperitoneal iliac veins and vena cava has been slow to be adopted into everyday use; however, current ultrasound technology allows more depth of penetration with improved image resolution. Gray-scale, color flow, and pulsed wave Doppler modalities are ideal for evaluation of the femoral-iliocaval outflow tract. Additional tools, such as chroma tint, power Doppler, and penetration harmonics, are useful for image optimization. Duplex ultrasound using the techniques described here needs to be compared and correlated with intravascular ultrasound imaging in a formal study that also looks at clinical outcomes and quality of life measures.

Synovial Chondromatosis in Patient Presenting with Chronic Venous Stasis Ulcers.

Synovial chondromatosis (SC) is a rare, benign synovial growth most frequently involving the knee or hip joint. Common presenting symptoms include pain throughout the affected joint, reduced range of motion, and a palpable mass. We present an unusual case of SC presenting with symptoms of chronic venous stasis ulcer. A 49-year-old patient presented with swelling, hyperpigmentation, and ulcerations of his right lower extremity. Work-up including duplex and computed tomography scan revealed a calcified mass in the hip joint, highly suspicious for SC. A joint surgical approach from a vascular and orthopedic surgeon successfully removed the growths and decompressed the surrounding vessels. The mass effect of the SC on overlying veins resulted in obstruction of venous return due and subsequent venous stasis ulcerations and symptoms of venous hypertension. We present this case due to the unique vascular sequelae related to the SC to explore this as a new diagnosis to consider in patients who present with venous stasis ulceration and radiographic findings consistent with SC.

Physiologic Guidance of Infrainguinal Vascular Interventions Using the Pressure Wire.

OBJECTIVES: To assess the relationship between the resting (RG) and hyperemic (HG) translesional peripheral gradients, with the functional and anatomic parameters before and after an infrainguinal endovascular procedure. BACKGROUND: RGs and HGs are objective tools in defining the hemodynamic significance of an arterial stenosis. METHODS: In 25 subjects with infrainguinal arterial stenosis, RG and HG were measured via a pressure wire before and after angioplasty. Before and after the procedure, all subjects had an ankle-brachial index (ABI) and Duplex ultrasound evaluation, recording prelesion and in-lesion peak systolic velocity (PSV-L), and calculating a peak systolic velocity ratio (PSV-R). A Pearson R correlation coefficient was calculated. RESULTS: The mean age was 73 ± 12 years, 70% were men, median Rutherford class 3. At baseline and after angioplasty, mean ABI was 0.78 ± 0.2 and 0.99 ± 0.1, mean PSV-L was 459 ± 110 cm/s and 126 ± 35 cm/s, and mean PSV-R was 6.7 ± 4 and 1.2 ± 0.5, respectively. RG and HG significantly improved (P<.001) from baseline to after angioplasty (28.7 ± 20.5 mm Hg to 5 ± 13 mm Hg and 40.2 ± 21.4 mm Hg to 10 ± 13 mm Hg, respectively). RG before and after the procedure correlated well with ABI (r = -0.58; r = -0.41), PSV-L (r = 0.40; r = 0.52), and PSV-R (r = 0.46; r = 0.42). An improvement of 9 mm Hg in RG predicted a change of 0.1 in ABI. CONCLUSIONS: Improvement in RG during endovascular intervention in superficial femoral artery correlates well with the improvement in ABI, PSV-L, and PSV-R. A postprocedural decrease in RG of 9 mm HG predicts an improvement in ABI of 0.1.