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PERIPHERAL VASCULAR ULTRASOUND
artery will demonstrate a peripheral arterial type waveform with overall flow in the forward direction as opposed to the high forward and reverse flow components seen in the necks of false aneurysms (Fig. 11.18).
Treatment of false femoral aneurysms
Traditionally, false aneurysms were repaired surgically, but ultrasound compression of pseudo-aneurysms has been demonstrated as a safe and effective technique for thrombosing false aneurysms. The patient should be lying supine, and some form of analgesia or sedation should be administered as the procedure can be uncomfortable. The distal ankle artery signals should be assessed with continuous wave Doppler to ensure there is good distal perfusion of the leg before beginning the proce- dure. Firm transducer pressure is applied over the point of communication between the true lumen and false lumen to occlude the arterial jet. Compression is maintained for 10 min intervals
References
Akkersdijk G J, van der Graaf Y, van Bockel J H, et al 1994 Mortality rates associated with operative treatment of infrarenal abdominal aortic aneurysms in The Netherlands. British Journal of Surgery 81(5):706–709
Ashton H A, Buxton M J, Day N E, et al 2002 The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised control trial. Lancet 360:1531–1539
Brown P M, Zelt D T, Sobolev B 2003 The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rates. Journal of Vascular Surgery 37(2):280–284
Johnston K W, Rutherford R B, Tilson M D, et al 1991 Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. Journal of Vascular Surgery 13(3):452–458
Kniemeyer H W, Kessler T, Reber P U, et al 2000 Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome
with a brief release of pressure to allow for distal perfusion. It may take over an hour to successfully thrombose the aneurysm.
More recently, ultrasound guided human throm- bin injection into the false lumen has proved to be a highly effective method of treating false aneurysms. Blood in the false lumen clots within 1 to 2 sec- onds of the injection, and this can be observed on the ultrasound image. Thrombin injection may become the main method of treating false femoral aneurysms (Olsen et al 2002).
REPORTING
Reporting is usually in the form of a written report accompanied by appropriate images recorded from the scanner. It is important to note any limitations of the scan and to state clearly what measurements were made and from what positions. Situations have occurred in which the points of measurement have been ambiguously reported and the overall length of an aneurysm has been mistakenly inter- preted as its diameter.
using a multi-organ dysfunction score. European Journal
of Vascular and Endovascular Surgery 19:190–196 McLafferty R B, McCrary B S, Mattos M A, et al 2002 The
use of color-flow duplex scan for the detection of
endoleaks. Journal of Vascular Surgery 36(1):100–104 Olsen D M, Rodriguez J A, Vranic M, et al 2002 A
prospective study of ultrasound scan-guided thrombin injection of femoral pseudoaneurysm: a trend towards minimal mediation. Journal of Vascular Surgery 36(4):779–782
Santilli S M, Wernsing S E, Lee E S 2000 Expansion rates and outcomes for iliac artery aneurysms. Journal of Vascular Surgery 31(1):114–121
The UK Small Aneurysm Trial Participants 1998 Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 352(9141):1649–1655
van Marrewijk C, Buth J, Harris P L, et al 2002 Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience.
Journal of Vascular Surgery 35(3):461–473
Vardulaki K A, Walker N M, Day N E, et al 2000 Quantifying the risks of hypertension, age, sex and