"To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms

Abstract

Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of "to-and-fro" waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of "to-and-fro" waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of "to-and-fro" waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and "to-and-fro" flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional "to-and-fro" waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the "to-and-fro" waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.

Giant pseudoaneurysm of the external carotid artery causing stroke: A case report

“…7 There was no record of neck trauma or previous surgery on the neck in our patient, and the pseudoaneurysm appeared to have arisen from an external carotid artery dissection caused by impingement of the external carotid artery by the elongated styloid process. A pseudoaneurysm can form as a result of a trauma, arterial dissection, vasculitides, or infection, or as an iatrogenic complication of some medical procedures.…”

Superficial temporal artery pseudoaneurysm: what is the role of ultrasound?

“…Occasionally, the neck is the only patent portion of the pseudoaneurysm if partial or total thrombosis has occurred. The radiologist should keep in mind that subcutaneous abscess or localized hematoma may transmit arterial pulsations and incorrectly suggest an aneurysm when thrill and bruit are absent [10,11].…”

External carotid artery pseudoaneurysm with arteriovenous fistula: A rare complication of glass shrapnel injury

“…Color Doppler also has the added benefit of velocity measurement over CT angiography. [8] Cerebral CT angiography is rapid, non-invasive, and very accurate in the diagnosis of neurovascular injuries. [6] Maximum intensity projection and three-dimensional volume rendering provides very good spatial resolution.…”