Advances in vascular anatomy and pathophysiology using high resolution and multiparametric sonography

Abstract

B-mode and Color Doppler are the first-line imaging modalities in cardiovascular diseases. However, conventional ultrasound (US) provides a lower spatial and temporal resolution (70–100 frames per second) compared to ultrafast technology which acquires several thousand frames per second. Consequently, the multiparametric ultrafast platforms manage new imaging algorithms as high-frequency ultrasound, contrast-enhanced ultrasound, shear wave elastography, vector flow, and local pulse wave imaging. These advances allow better ultrasound performances, more detailed blood flow visualization and vessel walls’ characterization, and many future applications for vascular viscoelastic properties evaluation. In this paper, we provide an overview of each new technique’s principles and concepts and the real or potential applications of these modalities on the study of the artery and venous anatomy and pathophysiology of the upper limb before and after creating a native or prosthetic arterio-venous fistula. In particular, we focus on high-frequency ultrasound that could predict cannulation readiness and its potential role in the venous valvular status evaluation before vascular access creation; on contrast-enhanced ultrasound that could improve the peri-operative imaging evaluation during US-guided angioplasty; on shear wave elastography and local pulse wave imaging that could evaluate preoperative vessels stiffness and their potential predictive role in vascular access failure; on vector flow imaging that could better characterize the different components of the vascular access complex flow.

CEUS-guided PTA on stenotic AVF: Morphological and functional point of view

“…In the sitting of vascular diagnostics, highfrequency ultrasounds, tissue elasto-sonography, vectorial Doppler, and contrast enhanced ultrasonography (CEUS) have been studied. 15,16 In particular, the use of ultrasound contrast media to improve angioplasty on malfunctioning AVFs could represent an evolution of the classical procedure supported by B-mode and color-Doppler analysis making a hybrid procedure between the iodinated contrast/X-ray-guided and the ultrasound-guided one. In this case, the advantages of both would be combined, limiting the known problems of allergic reactions or tolerability in hemodialysis patients undergoing the somministration of iodinated contrast medium.…”

“…In the sitting of vascular diagnostics, high-frequency ultrasounds, tissue elasto-sonography, vectorial Doppler, and contrast enhanced ultrasonography (CEUS) have been studied. 15,16…”