Introduction Vascular screening programs have been gaining popularity in recent years; however, most programs accept all patients willing to participate. This study was designed to determine the yield of disease when screening examinations are limited to those most at risk, to stratify the amount of disease present in the at-risk population, and to establish which patients might benefit most from vascular screening. Materials and Methods Patients enrolled in a community outreach program for seniors 55 years of age and older were asked to participate in a free vascular screening. Screenings consisted of completion of a questionnaire, physical examination, limited carotid artery evaluation for stenosis, aorta evaluation for detection of aneurysm, and ankle/brachial index (ABI) calculation to detect peripheral vascular disease. Findings were grouped into “Normal,” “Mild disease,” and “Significant disease.” Findings were then compared with the following controllable risk factors: hypertension, hyperlipidemia, diabetes, coronary artery disease (CAD), or smoking history. Results Between May 16 and October 17, 2007, 357 participants' (75 male, 157 female, mean age 72.9 years) results were analyzed. Overall, 140 participants (43%) had some form of vascular disease (“mild” and “significant” categories combined). Of 324 eligible participants, carotid findings showed 199 normal (61%), 104 mild (32%), and 21 significant (7%) results. Aorta findings showed 296 normal (91%), 25 mild (8%), and 3 significant (1%) results. ABI findings showed 278 normal (86%), 18 mild (6%), and 28 significant (8%) results. In participants with three or more risk factors, there was a greater probability that carotid (p = 0.0022) and peripheral vascular disease (p = 0.0003) would be detected; however, there was no predictive value for aortic aneurysm (p = 0.5). Conclusion Vascular screening programs focusing on the at-risk population may reduce unnecessary testing compared with programs evaluating all patients willing to participate.

Introduction Duplex ultrasound is a valuable modality for the assessment of hemodialysis access function. A potential complication of hemodialysis access is arterial steal, which occurs when venous outflow exceeds the capacity of the inflow artery, and flow in this distal artery becomes retrograde, stealing blood flow from the hand to the fistula site. A potential condition resulting from arterial steal is hand or digit ischemia. Distal revascularization-interval ligation (DRIL) procedures can be used to “bypass” the fistula or graft site and deliver blood to the hypoperfused hand. Presented is a case of an arterial steal with severe hand ischemia that was alleviated by a DRIL procedure. Case Study A 69-year-old woman presented to the vascular laboratory with an ischemic right hand and digital ulcer distal to a brachial-axillary arteriovenous graft (AVG). Duplex ultrasound was performed of the right upper-extremity inflow arteries, AVG, and outflow veins. Ipsilateral brachial, radial, and ulnar artery waveform analysis for direction of flow was performed with and without AVG compression. The evaluation revealed significant arterial ischemia that returned to normal after manual compression of the AVG. The patient underwent a DRIL procedure after the pre-op duplex evaluation. Postprocedural duplex evaluation revealed patent inflow and outflow vessels, patent graft, and bypass (DRIL) with antegrade flow in the brachial and radial arteries and no change of flow with manual graft compression; clinically, the patient had a healing ulceration of the digit. Conclusion Duplex ultrasound for hemodialysis access should not only be used to evaluate for patency of the fistula or graft but should include assessment for ischemia and/or steal. This case demonstrates the importance of the assessment of the distal arterial segments including digital waveforms, and the use of manual compression to complete the hemodialysis access evaluation. DRIL procedures can potentially correct arterial steal while preserving access function.

Introduction Color-flow duplex ultrasound is effective in the detection and quantification of carotid artery disease; however, diameter reduction estimates are most commonly derived by Doppler velocity measurements. In addition, direct visualization of the vessel lumen is only possible through the use of more expensive potentially invasive imaging procedures, such as computed tomography angiography, magnetic resonance angiography, and conventional angiography. Described here is a method to determine vessel diameter of the internal carotid artery (ICA) by the use of three-dimensional (3D) reconstruction of b-mode data to generate luminal diameter estimates. Materials and Methods A prospective review of 40 consecutive cerebrovascular duplex studies was performed. Testing protocols required transverse sweeps of the common carotid artery (CCA) and ICA in b-mode. Motion files were analyzed using software, which segmented the vessel lumen as the area of interest. The software created a 3D rendering of the lumen of the CCA and ICA. Vessel diameter reduction estimated by Doppler-derived velocities was then compared with the 3D rendering of the vessel lumen diameters. Results There was a 99% (n = 79, ρ = < 0.001) correlation between velocity estimates and 3D visualization for estimating diameter reduction. Correlation for cases with less than 50% diameter reduction by duplex was 100% (n = 66, ρ = < 0.004), whereas correlation for cases with 50% or greater diameter reduction by duplex was 92% (n = 13, ρ = < 0.03). Conclusion 3D reconstruction of the vessel lumen shows a statistically significant correlation with velocity-derived diameter reduction measurements. Although more investigation with a larger group of patients is necessary, 3D reconstruction may be a valuable adjunct and may enhance the diagnostic capabilities of color-flow duplex ultrasound.