Vascular ultrasound represents one of the first successful applications of Dopplcr ultrasound to clinical medicine, and it has evolved to be a versatile diagnostic test for the assessment of both arterial and venous disease. Given the anatomic extent and potential complexities of arterial and venous trees and the inherent requirements of ultrasound imaging, vascular ultrasound has its limitations, but when approached properly and formally (with thorough and structured protocols), it is a very useful diagnostic tool. Attention to technique and to detail and an attempt to have the greatest knowledge possible of native anatomy and its variants, vascular diseases and their permutations, and interventional and surgical techniques maximize the yield of vascular ultrasound.
The historic standard of comparison of vascular ultrasound has been conventional angiography/ venography. With the progress and developments of computed tomography (CT) angiography and magnetic resonance (MR) angiography, both of which also have as their basis of comparison conventional angiography, the respective roles of vascular ultrasound, GT angiography, and MR angiography arc evolving and are slowly being defined. Each modality has its strengths and weaknesses. CT and MR angiography are anatomic tests; vascular ultrasound is both a physiologic and an anatomic test. Vascular ultrasound is still currently the pre-eminent noninvasivc test of venous disease; CT venography is less competitive. CT angiography is certainly a rising contributor to the assessment of arterial disease, but vascular ultrasound remains a radiation-free means to initially assess arterial disease.
This book is our attempt to summarize and provide our experience, principles, and approach to the application of vascular ultrasound to the arterial and venous vascular fields, and also a platform from which to stalwartly encourage structured and thorough technique and protocol, as well as awareness of disease permutations.
It is our hope that this book will prove useful to those who are dedicated to providing care to patients through the clinical application of vascular ultrasound.
Acknowledgments. We acknowledge with appreciation Adricn Boutin, Vern M. Campbell, Tony M. Chou, Melma J. Evangelista, Allan J. Lossing, Krishnankutty Sudhir, Inga Tomas, William S. Tucker, and contributors Junya Ako, Joe Chauvapun, George E. Kopchok, Katsuhisa Waseda, and Rodney A. White. Stuart J. Hutchison Katherine C. Holmes

1 Technical Issues in Vascular Ultrasound 1

2 Carotid Artery Disease and Extracranial Cerebrovascular Disease 79

3 Upper Extremity Arterial Disease 69

4 Arteriovenous Fistulas 82

5 Lower Extremity Arterial Disease 96

6 Catheterization-Related Complications 133

7 The Abdominal Aorta 149

8 Renal Artery Disease 175

9 Splanchnic/Visceral Arteries 184

10 Venous Disease of the Upper Extremity 194

11 Venous Disease of the Lower Extremity 217

12 Intravascular Ultrasound 245

Junya Ako and Katsuhisa Waseda

13 Intravascular Ultrasound Imaging of the Descending Aorta and Iliac Arteries 253

George E. Kopchok, Joe Chauvapun, and Rodney A. White

Appendix 275

Index 293

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