Development of a Duplex Ultrasound Protocol for Baseline and Follow-Up Imaging of a Branched Aortic Endoprosthesis

Abstract

Branched endoprostheses for endovascular repair of pararenal and thoracoabdominal aortic aneurysms are undergoing evaluation in prospective clinical trials. Duplex ultrasound has been a cornerstone of surveillance for vascular reconstructions. This paper describes the development and deployment of a standardized duplex imaging protocol to evaluate individuals who have undergone endovascular repair of their thoracoabdominal aortic aneurysm. Ultrasound imaging is performed after an 8 to 12 hour fast to minimize the presence of bowel gas and allow for optimal imaging of abdominal vascular structures. Doppler measurements of peak systolic and end diastolic velocity are made at specific arterial segments in the aorta and the celiac, superior mesenteric, and renal arteries. Resistive indices are also recorded in the segmental and arcuate arteries of both kidneys. Pulsed-wave Doppler is used to record spectral Doppler data and color Doppler is used to image all arterial segments and ensure proper placement of the Doppler sample volume and ensure correct angle of interrogation. Implementation of a standardized duplex ultrasound imaging protocol can be used to image and follow individuals who have received the Thoracoabdominal Branch Endoprosthesis (TAMBE) device and branched endovascular aneurysm repair (BEVAR). Ultrasound may provide complementary findings and may add information to the computed tomography angiography imaging for following these individuals.

Doppler Study of the Left Common Carotid Artery With Pre-Occlusive Stenosis

“…On power Doppler, there was only a sliver of blood flow, while on spectral Doppler there was slow flow (15.5 cm/s); the velocity in the stenosis was decreased instead of increased as shown in Figures 2-4 from the case report. There was antegrade tardus-parvus flow 4 –6 in the left ICA (Figure 5) and retrograde flow in the left ECA (Figure 6). There was substantially low resistance flow in the left vertebral artery 7 (Figure 7).…”