Examination of Intercostal Arteries with Transthoracic Doppler Sonography

Koyanagi, Toshiya; Kawaharada, Nobuyoshi; Kurimoto, Yoshihiko; Ito, Toshiro; Baba, Tsuyoshi; Nakamura, Masanori; Watanebe, Atsushi; Higami, Tetsuya

doi:10.1111/j.1540-8175.2009.00970.x

Cited by 26 publications

(33 citation statements)

References 9 publications

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“…Use of ultrasound (US) to guide pleural procedures is associated with a reduced rate of adverse events [6], and its routine use has recently been advocated for all thoracocenteses and ICC insertions [4]. Doppler US has been extensively used to examine the vascular supply of pulmonary and chest wall tumours [7,8,9], and its ability to specifically image the ICA has been established [10,11]. However, acknowledgement of this has not been wide-spread in the international community, as evidenced by its absence in a number of recent reviews [12,13,14].…”

Section: Introductionmentioning

confidence: 99%

Thoracic Ultrasound Demonstrates Variable Location of the Intercostal Artery

et al. 2012

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Background: Ultrasound (US) guidance is advocated to reduce complications from thoracocentesis or intercostal catheter (ICC) insertion. Although imaging of the intercostal artery (ICA) with Doppler US has been reported, current thoracic guidelines do not advocate this, and bleeding from a lacerated ICA continues to be a rare but serious complication of thoracocentesis or ICC insertion. Objectives: It was the aim of this study to describe a method to visualise the ICA at routine US-guided thoracocentesis and map its course across the posterior chest wall. Method: The ICA was imaged in 22 patients undergoing US-guided thoracocentesis, at 4 positions across the back to the axilla. Its location, relative to the overlying rib, was calculated as the fraction of the intercostal space (ICS) below the inferior border of that rib. Results: An ICA was identified in 74 of 88 positions examined. The ICA migrated from a central ‘vulnerable’ location within the ICS near the spine (0.28, range 0.21–0.38; p < 0.001) towards the overlying rib (0.08, range 0.05–0.11; p < 0.001) in the axilla. Conclusions: The ICA can be visualised with US and is more exposed centrally within the ICS in more posterior positions; however, there is a marked variation between individuals, such that the ICA may lie exposed in the ICS even as far lateral as the axilla. Future studies need to identify which patients are at risk for a ‘low-lying’ ICA to further define the role of US imaging of the ICA during thoracocentesis or ICC insertion.

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Section: Introductionmentioning

confidence: 99%

Thoracic Ultrasound Demonstrates Variable Location of the Intercostal Artery

et al. 2012

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“…Although ED images of the velocity profile have been published, the estimates of blood flow obtained without calibration by making various suppositions look unreliable (Sloop et al ., ; Koyanagi et al ., ). The present data seem the first to provide a quantitative estimation of IC artery blood flow using ED technique relying on a calibration.…”

Section: Discussionmentioning

confidence: 99%

“…Non-invasive measurement of IC blood flow in humans using the echo-Doppler technique (ED) has not been validated yet, even though images of blood velocity in the IC arteries of humans have been published and estimates calculated (Sloop et al, 1998;Koyanagi et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of intercostal blood flow measurement by echo‐Doppler technique in healthy subjects

Bisschop

Montaudon

Glénet

et al. 2015

Clin Physio Funct Imaging

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Intercostal artery blood flow supplies the external and internal intercostal muscles, which are inspiratory and expiratory muscles. Intercostal blood flow measured by the echo-Doppler (ED) technique has not previously been reported in humans. This study describes the feasibility of this measurement during free and loaded breathing in healthy subjects. Systolic, diastolic and mean blood flows were measured in the eighth dorsal intercostal space during free and loaded breathing using the ED technique. Flows were calculated as the product of the artery intraluminal surface and blood velocity. Ten healthy subjects (42 ± 13·6 years) were included. Integrated electromyogram (iEMG), arterial pressure, cardiac frequency and breathing pattern were also recorded. Mean blood flows were 3·5 ± 1·2 ml min at rest, 6 ± 2·6 ml min while breathing through a combined inspiratory and expiratory resistance and 4·0 ± 1·3 ml min 1 min after unloading. Diastolic blood flow was about one-third the systolic blood flow. The changes in blood flows were consistent with those in iEMG. No change in mean blood flow was observed between inspiration and expiration, suggesting a balance in the perfusion of external and internal muscles during breathing. In conclusion, ED is a feasible technique for non-invasive, real-time measurement of intercostal blood flow in humans. In healthy subjects, mean blood flow appeared tightly matched to iEMG activity. This technique may provide a way to assess the vascular adaptations induced by diseases in which respiratory work is increased or cardiac blood flow altered.

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“…Ultrasound may identify unprotected intercostal arteries vulnerable to percutaneous pleural interventions [100]. SALAMONSEN et al [101] visualised intercostal arteries using colour Doppler and confirmed significant variation in their course.…”

Section: Chest Wall Abnormalitiesmentioning

confidence: 97%

The efficacy of bedside chest ultrasound: from accuracy to outcomes

Hew

Tay

2016

Eur Respir Rev

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For many respiratory physicians, point-of-care chest ultrasound is now an integral part of clinical practice. The diagnostic accuracy of ultrasound to detect abnormalities of the pleura, the lung parenchyma and the thoracic musculoskeletal system is well described. However, the efficacy of a test extends beyond just diagnostic accuracy. The true value of a test depends on the degree to which diagnostic accuracy efficacy influences decision-making efficacy, and the subsequent extent to which this impacts health outcome efficacy. We therefore reviewed the demonstrable levels of test efficacy for bedside ultrasound of the pleura, lung parenchyma and thoracic musculoskeletal system.For bedside ultrasound of the pleura, there is evidence supporting diagnostic accuracy efficacy, decisionmaking efficacy and health outcome efficacy, predominantly in guiding pleural interventions. For the lung parenchyma, chest ultrasound has an impact on diagnostic accuracy and decision-making for patients presenting with acute respiratory failure or breathlessness, but there are no data as yet on actual health outcomes. For ultrasound of the thoracic musculoskeletal system, there is robust evidence only for diagnostic accuracy efficacy.We therefore outline avenues to further validate bedside chest ultrasound beyond diagnostic accuracy, with an emphasis on confirming enhanced health outcomes. @ERSpublicationsThe next challenge in bedside chest ultrasound is to refocus from diagnostic accuracy toward patient outcomes http://ow.ly/NyNR3027WLU

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Examination of Intercostal Arteries with Transthoracic Doppler Sonography

Abstract: Evaluation technique of serial ICAs and LAs was shown. We think that it may be a clinically useful method in the study of spinal cord circulation in the repair of cases of descending thoracic or thoracoabdominal aortic aneurysm.

Cited by 26 publications

References 9 publications

Thoracic Ultrasound Demonstrates Variable Location of the Intercostal Artery

Thoracic Ultrasound Demonstrates Variable Location of the Intercostal Artery

Feasibility of intercostal blood flow measurement by echo‐Doppler technique in healthy subjects

The efficacy of bedside chest ultrasound: from accuracy to outcomes

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