Ultrasound assessment of the caliber of the arteries in the lower extremities in healthy persons – the dependency on age, sex and morphological parameters of the subjects
Abstract:AimThe aim of this paper was to evaluate the caliber of the following arteries in the lower extremities: the common femoral artery, superficial femoral artery, popliteal artery, posterior tibial artery and dorsalis pedis artery and to determine the relation of the calibers to age, sex and morphological parameters of the body such as weight, height and BMI of the subject.MaterialTwo hundred and twenty-eight healthy persons aged 18–81 were examined (average ±SD; 43.1±16.71): 134 women aged 19–74 (43.2±15.63) and… Show more
“…There are fairly robust ultrasound data demonstrating that the IJV is at its largest when supine and becomes progressively more narrowed as the patients sit upright; in the upright position, the IJV is 10% of its supine caliber, with paravertebral veins assuming most of the venous drainage. [7][8][9] Anecdotally, patients with symptomatic IJV stenosis often report symptom improvement while lying flat (which may mimic and be confused with spontaneous intracranial hypotension), likely because of improvement in jugular outflow in this position. Head rotation often narrows the IJV and produces symptoms.…”
Section: Interpretation Anatomic Considerations In the Treatment Of I...mentioning
BACKGROUND AND OBJECTIVES:
Cerebral venous outflow disorders (CVDs) secondary to internal jugular vein (IJV) stenosis are becoming an increasingly recognized cause of significant cognitive and functional impairment in patients. There are little published data on IJV stenting for this condition. This study aims to report on procedural success.
METHODS:
A single-center retrospective analysis was performed on patients with CVD that underwent IJV stenting procedures.
RESULTS:
From 2019 to 2023, 29 patients with CVD underwent a total of 33 IJV stenting procedures. Most patients (20; 69%) had an underlying connective tissue disorder diagnosis. The mean age of the included patients was 36.3 years (SD 12.4), 24 were female (82.8%), and all were Caucasian except for 2 patients (27; 93.0%). Twenty-eight procedures (85%) involved isolated IJV stenting under conscious sedation, whereas 5 procedures (15%) involved IJV stenting and concomitant transverse sinus stenting under general anesthesia. Thirteen (39%) patients underwent IJV stenting after open IJV decompression and styloidectomy. Three patients had stents placed for stenosis below the C1 tubercle, one of which was for carotid compression. Periprocedural complications occurred in 11 (33%), including intracardiac stent migration in 1 patient, temporary shoulder pain/weakness in 5 (15%), and persistent and severe shoulder pain/weakness in 2 patients (6%). Approximately 75% of patients demonstrated improvement after stenting although only 12 patients (36%) had durable improvement over a mean follow-up of 4.5 months (range 6 weeks-3.5 years).
CONCLUSION:
Our experience, along with early published studies, suggests that there is significant promise to IJV revascularization techniques in these patients; however, stenting carries a high complication rate, and symptom recurrence is common. Most neurointerventionalists should not be performing IJV stenting unless they have experience with these patients and understand technical nuances (stent sizing, anatomy, patient selection), which can maximize benefit and minimize risk.
“…There are fairly robust ultrasound data demonstrating that the IJV is at its largest when supine and becomes progressively more narrowed as the patients sit upright; in the upright position, the IJV is 10% of its supine caliber, with paravertebral veins assuming most of the venous drainage. [7][8][9] Anecdotally, patients with symptomatic IJV stenosis often report symptom improvement while lying flat (which may mimic and be confused with spontaneous intracranial hypotension), likely because of improvement in jugular outflow in this position. Head rotation often narrows the IJV and produces symptoms.…”
Section: Interpretation Anatomic Considerations In the Treatment Of I...mentioning
BACKGROUND AND OBJECTIVES:
Cerebral venous outflow disorders (CVDs) secondary to internal jugular vein (IJV) stenosis are becoming an increasingly recognized cause of significant cognitive and functional impairment in patients. There are little published data on IJV stenting for this condition. This study aims to report on procedural success.
METHODS:
A single-center retrospective analysis was performed on patients with CVD that underwent IJV stenting procedures.
RESULTS:
From 2019 to 2023, 29 patients with CVD underwent a total of 33 IJV stenting procedures. Most patients (20; 69%) had an underlying connective tissue disorder diagnosis. The mean age of the included patients was 36.3 years (SD 12.4), 24 were female (82.8%), and all were Caucasian except for 2 patients (27; 93.0%). Twenty-eight procedures (85%) involved isolated IJV stenting under conscious sedation, whereas 5 procedures (15%) involved IJV stenting and concomitant transverse sinus stenting under general anesthesia. Thirteen (39%) patients underwent IJV stenting after open IJV decompression and styloidectomy. Three patients had stents placed for stenosis below the C1 tubercle, one of which was for carotid compression. Periprocedural complications occurred in 11 (33%), including intracardiac stent migration in 1 patient, temporary shoulder pain/weakness in 5 (15%), and persistent and severe shoulder pain/weakness in 2 patients (6%). Approximately 75% of patients demonstrated improvement after stenting although only 12 patients (36%) had durable improvement over a mean follow-up of 4.5 months (range 6 weeks-3.5 years).
CONCLUSION:
Our experience, along with early published studies, suggests that there is significant promise to IJV revascularization techniques in these patients; however, stenting carries a high complication rate, and symptom recurrence is common. Most neurointerventionalists should not be performing IJV stenting unless they have experience with these patients and understand technical nuances (stent sizing, anatomy, patient selection), which can maximize benefit and minimize risk.
“…There is very little anatomical variation of the posterior tibial artery at the level of the medial malleolus, as it lies within the tarsal tunnel in 91% of the population [ 12 ]. The posterior tibial artery and dorsalis pedis artery are similarly small calibre arteries (between 1.96-2.05 mm) [ 13 ] which can make detection challenging, with further difficulties arising in larger limbs, the presence of oedema and excess adiposity [ 11 ]. Fig 3 Locations for pulse insonation, Left) from proximal to distal, the peroneal pulse, anterior tibial, dorsalis pedis pulse, and the distal dorsalis pedis pulse Right) posterior tibial pulse …”
Section: Introductionmentioning
confidence: 99%
“…The dorsalis pedis artery is congenitally absent in approximately 7% of the population [ 14 ], and has five different, typical anatomical patterns [ 15 , 16 ]. This, combined with the small calibre of the artery [ 13 ] can make it more challenging to insonate. The anterior tibial artery, can be easier to locate at the distal medial border of the tibia [ 10 ], and clinicians may choose to trace the artery from this point, distally, to locate the dorsalis pedis signal.…”
Doppler is the most commonly utilised vascular assessment tool by podiatrists in Australia and the United Kingdom. Doppler is a key component of many international guidelines for vascular assessment. Used alongside pressure measurements such as ankle and toe-brachial indices, Doppler assists podiatrists to diagnose, triage and subsequently manage patients with peripheral arterial disease. This commentary aims to clarify the importance, technique, and interpretation of continuous wave handheld Doppler in podiatry practice. This commentary presents discussion on the equipment and optimal test conditions for use of Doppler, and guidance on the technique required in podiatry clinical practice. Furthermore, there is a focus on interpretation of the output from Doppler including both audio and visual output. There is in depth discussion about identifying pathology and integration into the clinical management plan.
“…For example, women often have smaller femoropopliteal vessels and underrepresented minorities have been demonstrated to have a greater anatomic lesion complexity. 8,9 Notably, these subgroups are underrepresented even among the most contemporary clinical studies. For example, the broadly anticipated and discussed BEST-CLI trial included 72% White patients and 72% male patients.…”
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