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Book Details
Abstract
Now in its 6th edition, Introduction to Vascular Ultrasonography, by Drs. John Pellerito and Joseph Polak, provides an easily accessible, concise overview of arterial and venous ultrasound. A new co-editor and new contributors have updated this classic with cutting-edge diagnostic procedures as well as new chapters on evaluating organ transplants, screening for vascular disease, correlative imaging, and more. High-quality images, videos, and online access make this an ideal introduction to this complex and rapidly evolving technique.
- Find information quickly with sections organized by clinical rationale, anatomy, examination technique, findings, and interpretation.
- Get a thorough review of ultrasound vascular diagnosis, including peripheral veins and arteries, carotid and vertebral arteries, abdominal vessels, and transcranial Doppler.
- Quickly reference numerous tables for examination protocols, normal values, diagnostic parameters, and ultrasound findings for selected conditions.
- Visualize important techniques with hundreds of lavish line drawings and clinical ultrasound examples.
- Stay current with trending topics through new chapters on evaluation of organ transplants, screening for vascular disease, correlative imaging, and accreditation and the vascular lab.
- Experience clinical scenarios with vivid clarity through new color ultrasound images.
- Watch vascular ultrasound videos and access the complete contents online at www.expertconsult.com.
- Benefit from the fresh perspective and insight of a new co-editor, Dr. Joseph Polak.
- Improve your understanding of the correlation of imaging results with treatment goals in venous and arterial disease.
Learn the principles of vascular ultrasonography from the most trusted reference in the field.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Introduction to Vascular Ultrasonography | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Acknowledgments | vii | ||
| About the Editors | ix | ||
| Preface | xi | ||
| Contributors | xiii | ||
| Contents | xvii | ||
| SECTION 1 - Basics | 1 | ||
| Chapter 1 - HEMODYNAMIC CONSIDERATIONS IN PERIPHERAL VASCULAR AND CEREBROVASCULAR DISEASE | 3 | ||
| Physiologic Factors Governing Blood Flow and Its Characteristics | 3 | ||
| Effects of Arterial Obstruction | 11 | ||
| Venous Hemodynamics | 15 | ||
| Summary | 19 | ||
| REFERENCES | 19 | ||
| Chapter 2 - PHYSICS AND INSTRUMENTATION IN DOPPLER AND B-MODE ULTRASONOGRAPHY | 20 | ||
| Sound Propagation in Tissue | 20 | ||
| B-Mode Imaging | 26 | ||
| Transducer Properties | 29 | ||
| Special Processing Techniques | 34 | ||
| Doppler Ultrasound | 38 | ||
| Color Flow Imaging | 45 | ||
| Beyond Two-Dimensional Imaging | 47 | ||
| Equipment Safety | 50 | ||
| REFERENCES | 51 | ||
| Chapter 3 - BASIC CONCEPTS OF DOPPLER FREQUENCY SPECTRUM ANALYSIS AND ULTRASOUND BLOOD FLOW IMAGING | 52 | ||
| Spectrum Analysis | 52 | ||
| Auditory Spectrum Analysis | 54 | ||
| Diagnosis of Arterial Obstruction | 58 | ||
| Color Flow Ultrasound Imaging | 63 | ||
| Three-dimensional Vascular Imaging | 70 | ||
| B-mode Flow Imaging | 71 | ||
| REFERENCES | 72 | ||
| Chapter 4 - VASCULAR APPLICATIONS OF ULTRASOUND CONTRAST AGENTS | 74 | ||
| Introduction | 74 | ||
| Types of Ultrasound Contrast Agents | 74 | ||
| Clinical Applications of UCAs | 78 | ||
| Conclusions | 83 | ||
| REFERENCES | 84 | ||
| SECTION 2 - Cerebral Vessels | 89 | ||
| Chapter 5 - THE ROLE OF ULTRASOUND IN THE MANAGEMENT OF CEREBROVASCULAR DISEASE | 91 | ||
| Carotid Atherosclerotic Disease: Clinical Implications of Early Detection | 92 | ||
| Carotid Stenosis Measured by Ultrasound | 94 | ||
| Identifying Vulnerable Carotid Plaques: The Role of Ultrasound | 98 | ||
| Assessment Following Carotid Endarterectomy and Carotid Stents | 100 | ||
| Carotid Artery Occlusion and Dissection | 101 | ||
| Vertebral Artery Stenosis or Occlusion | 102 | ||
| Normal Intracranial Flow Findings | 104 | ||
| Intracranial Atherosclerotic Disease | 105 | ||
| Arterial Occlusion and Recanalization Monitoring | 111 | ||
| Collateral Patterns and Flow Direction | 111 | ||
| Identification of Lesions Amenable to Intervention in Acute Stroke | 113 | ||
| Monitoring Thrombolytic Therapy With Ultrasound | 114 | ||
| Ultrasound-Enhanced Thrombolysis | 115 | ||
| Gaseous Microspheres and Sonolysis | 116 | ||
| Specific TCD Applications in Cerebrovascular Diseases | 117 | ||
| Cerebral Vasomotor Reactivity, Breath-Holding Index | 120 | ||
| Reversed Robin Hood Syndrome | 121 | ||
| REFERENCES | 122 | ||
| Chapter 6 - NORMAL CEREBROVASCULAR ANATOMY AND COLLATERAL PATHWAYS | 128 | ||
| Vascular Anatomy | 128 | ||
| Cerebral Hemodynamics | 131 | ||
| Collateralization | 132 | ||
| Conclusions | 135 | ||
| REFERENCES | 135 | ||
| Chapter 7 - NORMAL FINDINGS AND TECHNICAL ASPECTS OF CAROTID SONOGRAPHY | 136 | ||
| Ultrasound Appearance of the Normal Carotid Artery Walls | 136 | ||
| Normal Blood Flow Characteristics | 136 | ||
| Vessel Identity | 140 | ||
| Examination Protocol | 141 | ||
| Instrumentation | 142 | ||
| Patient Position | 142 | ||
| Transducer Position | 142 | ||
| Carotid Artery Versus Jugular Vein | 142 | ||
| Image Orientation | 142 | ||
| Recording | 142 | ||
| The Examination Sequence | 143 | ||
| REFERENCES | 146 | ||
| Chapter 8 - ULTRASOUND ASSESSMENT OF CAROTID PLAQUE | 147 | ||
| Early Plaque Detection: Intima-Media Thickening | 147 | ||
| Methodology of Plaque Characterization | 148 | ||
| Characterization of Plaque: Homogeneous or Heterogeneous | 149 | ||
| Plaque Pathogenesis | 151 | ||
| New Methodologies | 153 | ||
| Ultrasound Contrast and Plaque Characterization | 154 | ||
| Ulceration | 155 | ||
| Conclusions | 155 | ||
| REFERENCES | 155 | ||
| Chapter 9 - ULTRASOUND ASSESSMENT OF CAROTID STENOSIS | 158 | ||
| ICA Stenosis | 158 | ||
| The Common Carotid Artery | 167 | ||
| The External Carotid Artery | 169 | ||
| The Innominate Artery | 169 | ||
| Summary | 172 | ||
| REFERENCES | 172 | ||
| Chapter 10 - CAROTID OCCLUSION, UNUSUAL PATHOLOGIES, AND DIFFICULT CAROTID CASES | 174 | ||
| Carotid Occlusion | 174 | ||
| Carotid Artery Dissection | 176 | ||
| Carotid Pseudoaneurysm | 178 | ||
| Carotid Arteriovenous Fistula | 180 | ||
| Fibromuscular Dysplasia | 181 | ||
| Carotid Body Tumor | 181 | ||
| Difficult Carotid Cases | 183 | ||
| REFERENCES | 190 | ||
| Chapter 11 - ULTRASOUND ASSESSMENT OF THE VERTEBRAL ARTERIES | 192 | ||
| Examination Techniques | 192 | ||
| Vertebral Artery Hemodynamics: Qualitative Assessment | 194 | ||
| Vertebral Artery Hemodynamics: Quantitative Assessment | 198 | ||
| Treatment of Disease | 200 | ||
| Conclusions | 200 | ||
| REFERENCES | 201 | ||
| Chapter 12 - ULTRASOUND ASSESSMENT OF THE INTRACRANIAL ARTERIES | 202 | ||
| Examination Techniques | 202 | ||
| Diagnostic Parameters for Specific Clinical Applications | 212 | ||
| New Developments | 221 | ||
| Conclusions | 225 | ||
| REFERENCES | 225 | ||
| SECTION 3 - Extremity Arteries | 229 | ||
| Chapter 13 - ARTERIAL ANATOMY OF THE EXTREMITIES | 231 | ||
| Upper Extremity | 231 | ||
| Lower Extremity | 233 | ||
| REFERENCES | 243 | ||
| Chapter 14 - NONIMAGING PHYSIOLOGIC TESTS FOR ASSESSMENT OF LOWER EXTREMITY ARTERIAL DISEASE | 244 | ||
| Instrumentation | 244 | ||
| Physiologic Testing Procedures | 250 | ||
| Diagnostic Algorithm | 257 | ||
| Clinical Applications | 258 | ||
| Conclusions | 260 | ||
| REFERENCES | 260 | ||
| Chapter 15 - ASSESSMENT OF UPPER EXTREMITY ARTERIAL OCCLUSIVE DISEASE | 262 | ||
| Diagnostic Workup | 262 | ||
| Choosing the Right Diagnostic Tool | 262 | ||
| Start With the Basics | 263 | ||
| Is There a Problem at the Thoracic Outlet? | 265 | ||
| Photoplethysmography of Digital Flow Evaluation | 266 | ||
| When to Add Duplex Imaging | 268 | ||
| Check for Vertebral-to-Subclavian Steal | 276 | ||
| Conclusions: Answering the Clinical Question | 279 | ||
| REFERENCES | 280 | ||
| Chapter 16 - ULTRASOUND EVALUATION BEFORE AND AFTER HEMODIALYSIS ACCESS | 281 | ||
| Basic Concepts of Hemodialysis Access | 281 | ||
| Descriptive Terminology | 282 | ||
| Vascular Mapping Before Hemodialysis Access Placement | 282 | ||
| Key Additional Points Regarding Preoperative Mapping | 286 | ||
| AVF Maturity Assessment | 287 | ||
| Key Additional Points Regarding AVF Evaluation | 289 | ||
| Graft Evaluation | 291 | ||
| Key Additional Points Regarding Graft Evaluation | 291 | ||
| REFERENCES | 293 | ||
| Chapter 17 - ULTRASOUND ASSESSMENT OF LOWER EXTREMITY ARTERIES | 294 | ||
| Instrumentation | 294 | ||
| Duplex Ultrasound Technique | 295 | ||
| Classification of Disease | 298 | ||
| Clinical Applications | 301 | ||
| Conclusions | 305 | ||
| REFERENCES | 305 | ||
| Chapter 18 - ULTRASOUND ASSESSMENT DURING AND AFTER CAROTID AND PERIPHERAL INTERVENTION | 307 | ||
| Intraprocedural Duplex Ultrasound Assessment | 307 | ||
| Surveillance after Intervention | 313 | ||
| Conclusions | 322 | ||
| REFERENCES | 323 | ||
| Chapter 19 - ULTRASOUND IN THE ASSESSMENT AND MANAGEMENT OF ARTERIAL EMERGENCIES | 324 | ||
| Ruptured Abdominal Aortic Aneurysm | 324 | ||
| Carotid Artery Stenosis | 326 | ||
| Carotid Artery Dissection | 326 | ||
| Acute Lower Extremity Ischemia | 328 | ||
| Femoral Pseudoaneurysm | 331 | ||
| Traumatic Arteriovenous Fistula | 334 | ||
| Penetrating Arterial Trauma | 335 | ||
| Conclusions | 338 | ||
| REFERENCES | 338 | ||
| SECTION 4 - Extremity Veins | 341 | ||
| Chapter 20 - RISK FACTORS AND THE ROLE OF ULTRASOUND IN THE MANAGEMENT OF EXTREMITY VENOUS DISEASE | 343 | ||
| Acute Venous Thromboembolic Disease | 343 | ||
| Anticoagulation and Thrombolysis in the Management of Venous Thromboembolic Disease | 344 | ||
| Acute Deep Venous Thrombosis of Specific Extremity Veins | 345 | ||
| Extremity Vein Duplex Scanning to Diagnose Pulmonary Embolism | 346 | ||
| Superficial Venous Thrombosis | 347 | ||
| Axillary-Subclavian Venous Thrombosis | 347 | ||
| Sequelae of Deep Venous Thrombosis | 348 | ||
| Varicose Veins | 349 | ||
| Mapping for Bypass Surgery | 350 | ||
| REFERENCES | 351 | ||
| Chapter 21 - EXTREMITY VENOUS ANATOMY AND TECHNIQUE FOR ULTRASOUND EXAMINATION | 353 | ||
| Anatomy of the Lower Extremity | 353 | ||
| Venous Duplex Imaging Examination Technique and Protocol | 354 | ||
| Characterization of Thrombus | 358 | ||
| The Venous Anatomy and Examination Protocol | 362 | ||
| Anatomy of the Upper Extremity | 370 | ||
| Upper Extremity Examination Protocol | 371 | ||
| REFERENCES | 376 | ||
| Chapter 22 - ULTRASOUND DIAGNOSIS OF LOWER EXTREMITY VENOUS THROMBOSIS | 377 | ||
| Technique and Normal Anatomy | 378 | ||
| Normal Findings | 383 | ||
| Ultrasound Findings of Venous Thrombosis | 383 | ||
| Common Pitfalls | 384 | ||
| Acute versus Chronic DVT | 384 | ||
| Incidental Findings/Alternative Diagnoses | 387 | ||
| Conclusions | 387 | ||
| REFERENCES | 394 | ||
| Chapter 23 - CONTROVERSIES IN VENOUS ULTRASOUND | 396 | ||
| How Much is Enough? | 396 | ||
| The Role of the Unilateral Venous Ultrasound Examination in the Patient With Unilateral Symptoms | 396 | ||
| Bilateral Symptoms: The Role of the Bilateral Venous Examination | 397 | ||
| The Extent of the Ultrasound Examination: How Much Needs to Be Studied? | 398 | ||
| Calf Vein Thrombosis | 399 | ||
| Compression Ultrasound Causing Pulmonary Embolus | 401 | ||
| DVT in Occult Malignancy | 401 | ||
| Ultrasound for the Assessment of Pulmonary Embolus | 403 | ||
| Confusing Terminology | 403 | ||
| Risk Factors for Deep Venous Thrombosis | 404 | ||
| Conclusions | 405 | ||
| REFERENCES | 405 | ||
| Chapter 24 - ULTRASOUND DIAGNOSIS OF VENOUS INSUFFICIENCY | 408 | ||
| Pathophysiology of Venous Insufficiency | 408 | ||
| Clinical Signs and Symptoms | 409 | ||
| Vascular Laboratory Test Procedures | 409 | ||
| Segmental Venous Incompetence | 424 | ||
| Conclusions | 427 | ||
| REFERENCES | 427 | ||
| Chapter 25 - NONVASCULAR PATHOLOGY ENCOUNTERED DURING VENOUS SONOGRAPHY | 429 | ||
| Soft Tissue Edema | 429 | ||
| Lymphedema | 430 | ||
| Hematoma | 430 | ||
| Muscle Injury | 430 | ||
| Lymph Nodes | 431 | ||
| Popliteal (Baker’s) Cysts | 432 | ||
| Joint Effusion | 433 | ||
| Infection | 433 | ||
| Soft Tissue Tumors | 434 | ||
| REFERENCES | 435 | ||
| SECTION 5 - Abdomen and Pelvis | 437 | ||
| Chapter 26 - ANATOMY AND NORMAL DOPPLER SIGNATURES OF ABDOMINAL VESSELS | 439 | ||
| Abdominal Aorta | 439 | ||
| Celiac Artery | 439 | ||
| Splenic Artery | 440 | ||
| Hepatic Artery | 440 | ||
| Superior and Inferior Mesenteric Arteries | 441 | ||
| Portal Venous System | 443 | ||
| Hepatic Veins | 444 | ||
| Inferior Vena Cava | 446 | ||
| Renal Arteries | 447 | ||
| Renal Veins | 447 | ||
| REFERENCES | 448 | ||
| Chapter 27 - ULTRASOUND ASSESSMENT OF THE ABDOMINAL AORTA | 450 | ||
| Anatomy | 450 | ||
| Normal Sizes | 450 | ||
| Normal Doppler Velocity Profiles | 450 | ||
| Pathologic States | 451 | ||
| Abdominal Aortic Aneurysm | 452 | ||
| Ultrasound Examination | 455 | ||
| Definition of an Aneurysm: Size Thresholds | 457 | ||
| Growth Rate of Aneurysms | 458 | ||
| Common Iliac Artery Aneurysms | 459 | ||
| Aneurysm Complications | 459 | ||
| Varied Pathologies | 460 | ||
| Postoperative Assessment | 461 | ||
| Conclusions | 464 | ||
| REFERENCES | 465 | ||
| Chapter 28 - ULTRASOUND IMAGING ASSESSMENT FOLLOWING ENDOVASCULAR AORTIC ANEURYSM REPAIR | 466 | ||
| Endovascular Grafts: Overview and General Considerations | 466 | ||
| Color Doppler Ultrasound Technique | 469 | ||
| Endoleak Detection | 472 | ||
| Aneurysm Size | 475 | ||
| Endovascular Graft Deformity and Native Artery Complications | 476 | ||
| Personal Commentary | 477 | ||
| Sac Pressure Measurement | 477 | ||
| Conclusions | 477 | ||
| REFERENCES | 478 | ||
| Chapter 29 - ULTRASOUND ASSESSMENT OF THE SPLANCHNIC (MESENTERIC) ARTERIES | 480 | ||
| Anatomy, Physiology, and Natural History of Bowel Ischemia | 480 | ||
| Technique | 483 | ||
| Examination Protocol | 486 | ||
| Diagnostic Criteria | 486 | ||
| Role of Duplex Ultrasound in Surveillance Following Mesenteric Revascularization (Stent Angioplasty and Bypass Graft Assessment) | 488 | ||
| Keys to Successful Examination | 488 | ||
| Pitfalls | 490 | ||
| Conclusions | 493 | ||
| REFERENCES | 493 | ||
| Chapter 30 - ULTRASOUND ASSESSMENT OF THE HEPATIC VASCULATURE | 495 | ||
| Technique and Normal Hemodynamics | 495 | ||
| Portal Hypertension | 497 | ||
| Portal Vein Thrombosis | 504 | ||
| Portal Vein Gas | 509 | ||
| Hepatic Vein Obstruction | 510 | ||
| Transjugular Intrahepatic Portosystemic Shunts | 512 | ||
| REFERENCES | 514 | ||
| Chapter 31 - ULTRASOUND ASSESSMENT OF NATIVE RENAL VESSELS | 517 | ||
| Anatomy | 517 | ||
| Principles of Examination | 517 | ||
| Technique | 518 | ||
| Protocol | 519 | ||
| Vascular Disorders | 521 | ||
| REFERENCES | 536 | ||
| Chapter 32 - DUPLEX ULTRASOUND EVALUATION OF THE UTERUS AND OVARIES | 540 | ||
| Technical Issues | 540 | ||
| Normal Anatomy and Hemodynamics | 541 | ||
| Current Applications | 543 | ||
| Ectopic Pregnancy | 545 | ||
| Pseudogestation | 547 | ||
| Value of Doppler for Evaluation of Ectopic Pregnancy | 547 | ||
| Pitfalls | 548 | ||
| Conclusions | 556 | ||
| REFERENCES | 557 | ||
| Chapter 33 - DUPLEX ULTRASOUND EVALUATION OF THE MALE GENITALIA | 559 | ||
| The Scrotum | 559 | ||
| Erectile Dysfunction | 569 | ||
| REFERENCES | 576 | ||
| Chapter 34 - EVALUATION OF ORGAN TRANSPLANTS | 579 | ||
| Renal Transplantation | 579 | ||
| Hepatic Transplantation | 597 | ||
| REFERENCES | 611 | ||
| Chapter 35 - SCREENING FOR VASCULAR DISEASE | 614 | ||
| Definition and Types of Screening | 614 | ||
| Screening for Asymptomatic Carotid Stenosis | 615 | ||
| Abdominal Aneurysm Screening | 619 | ||
| Screening for Cardiovascular Disease: Risk and Subclinical Cardiovascular Disease | 622 | ||
| Conclusions | 626 | ||
| REFERENCES | 626 | ||
| Chapter 36 - CORRELATIVE IMAGING | 629 | ||
| Overview | 629 | ||
| Arteriography | 629 | ||
| Digital Imaging | 630 | ||
| Computed Tomography Angiography | 632 | ||
| Magnetic Resonance Angiography | 635 | ||
| Overview and Correlative Findings | 638 | ||
| Conclusions | 646 | ||
| REFERENCES | 647 | ||
| Chapter 37 - ACCREDITATION AND THE VASCULAR LABORATORY | 648 | ||
| History and Organizational Structure | 648 | ||
| ICAVL Accreditation as a Model | 649 | ||
| IAC Merger | 649 | ||
| ICAVL Standards | 649 | ||
| Payment Policies | 651 | ||
| United Healthcare | 652 | ||
| Current ICAVL Statistics | 652 | ||
| Benefits of Accreditation | 652 | ||
| REFERENCES | 653 | ||
| INDEX | 655 |