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Two patients had an acute dissection of the right common carotid artery due to catheterization of the vessel during Seldinger angiography. Both patients were evaluated immediately after the traumatic event by means of echo-pulsed Doppler (duplex scan) to check the hemodynamic significance of the lesion. In the first case, the lesion initially appeared insignificant, but on the second day duplex scanning showed a sudden reduction of the flow in the internal carotid artery due to progression of the carotid dissection: the patient, neurologically asymptomatic, was operated on successfully. The second patient, also asymptomatic, underwent emergency surgical treatment after the first duplex scan showed significant reduction of the internal carotid flow. The postoperative course has been uneventful. Both patients are asymptomatic eighteen and eight months after surgery. The authors emphasize the important role that duplex ultrasonography played in the management of these 2 patients. [ABSTRACT FROM AUTHOR]

Doppler above-ankle pressure index (API) was monitored during 368 consecutive bilateral aortoiliac or aortofemoral graft reconstructions performed for aneurysmal or occlusive disease. The aim of this study was to investigate the variations of peripheral pressure, during and just after completion of the procedure, either when followed by immediate and definitive success or when an intraoperative correction or an early postoperative reoperation was necessary owing to postreconstructive ischemia. For this purpose the API courses were subdivided into three groups: A (705 limbs), which underwent immediately successful reconstructions; B (22 limbs), which needed intraoperative correction; C (9 limbs), which required early reoperation. All 736 limbs were studied individually as monolateral reconstructions and classified into six subgroups: 1, pervious iliac, pervious femoral artery; 2, occluded iliac, pervious femoral; 3, pervious iliac, stenotic femoral (i.e, stenosis > 75% of the superficial femoral artery); 4, occluded iliac, stenotic femoral; 5, pervious iliac, occluded femoral; 6, occluded iliac, occluded femoral. APIs were monitored before the operation (PRE), at the completion of the distal anastomosis (DEC), and five, fifteen, thirty, and forty-five minutes after. Data were statistically analyzed by multivariate analysis in regards to 705 immediately successful limbs (group A) and by comparison of all corrected or reoperated cases (groups B and C) with the lower bound of the fifth centiles of group A. The results in group A show that: API-PRE is different in the six subgroups (p< 0.001); API-DEC is lower than API-PRE in the patent iliac artery sub-groups (1,3, and 5) and higher than API-PRE in the occluded iliac artery sub-groups (2,4, and 6) (p always < 0.001). From declamping time to the forty-five-minutes observation, the mean courses turn out parallel and rising but on different levels (p< 0.001): pervious femoral, stenotic femoral, occluded... [ABSTRACT FROM AUTHOR]

Two patients had an acute dissection of the right common carotid artery due to catheterization of the vessel during Seldinger angiography. Both patients were evaluated immediately after the traumatic event by means of echo-pulsed Dop pler (duplex scan) to check the hemodynamic significance of the lesion. In the first case, the lesion initially appeared insignificant, but on the second day duplex scanning showed a sudden reduction of the flow in the internal carotid artery due to progression of the carotid dissection: the patient, neurologically asymp tomatic, was operated on successfully.The second patient, also asymptomatic, underwent emergency surgical treat ment after the first duplex scan showed significant reduction of the internal carotid flow. The postoperative course has been uneventful. Both patients are asympto matic eighteen and eight months after surgery.The authors emphasize the important role that duplex ultrasonography played in the management of these 2 patients. [ABSTRACT FROM PUBLISHER]

Doppler above-ankle pressure index (API) was monitored during 368 consec utive bilateral aortoiliac or aortofemoral graft reconstructions performed for aneurysmal or occlusive disease. The aim of this study was to investigate the variations of peripheral pressure, during and just after completion of the proce dure, either when followed by immediate and definitive success or when an intraoperative correction or an early postoperative reoperation was necessary owing to postreconstructive ischemia. For this purpose the API courses were subdivided into three groups: A (705 limbs), which underwent immediately suc cessful reconstructions; B (22 limbs), which needed intraoperative correction; C (9 limbs), which required early reoperation. All 736 limbs were studied individ ually as monolateral reconstructions and classified into six subgroups: 1, pervi ous iliac, pervious femoral artery; 2, occluded iliac, pervious femoral; 3, pervi ous iliac, stenotic femoral (i.e, stenosis > 75% of the superficial femoral artery); 4, occluded iliac, stenotic femoral; 5, pervious iliac, occluded femoral; 6, oc cluded iliac, occluded femoral. APIs were monitored before the operation (PRE), at the completion of the distal anastomosis (DEC), and five, fifteen, thirty, and forty-five minutes after.Data were statistically analyzed by multivariate analysis in regards to 705 immediately successful limbs (group A) and by comparison of all corrected or reoperated cases (groups B and C) with the lower bound of the fifth centiles of group A.The results in group A show that: API-PRE is different in the six subgroups (p < 0.001); API-DEC is lower than API-PRE in the patent iliac artery sub groups (1,3, and 5) and higher than API-PRE in the occluded iliac artery sub groups (2,4, and 6) (p always < 0.001). From declamping time to the forty-five- minutes observation, the mean courses turn out parallel and rising but on dif ferent levels (p < 0.001): pervious femoral, stenotic femoral, occluded femoral. API-forty-five minutes is higher than API-PRE in occluded iliac artery subgroups (2, 4, and 6) (p < 0.001), whereas in the patent iliac artery subgroups only the fifth subgroups reveals a slight but significant rise (p < 0.01), probably owing to the high rate of profunda femoral endarterectomy or angioplasty asso ciated with aortofemoral reconstructions.APIs values of 31 cases in groups B and C, compared with the lower bound of the fifth centile of group A, show that 8/31 cases (26%) remain above that bound, while 23/31 cases (74%) fall below it. [ABSTRACT FROM PUBLISHER]