Feasibility of transgastric ultrasonography of the abdominal aorta

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Presentation transcript:

Feasibility of transgastric ultrasonography of the abdominal aorta Richard R. Keen, MD, James S.T. Yao, MD, PhD, Patricia Astleford, RN, Donna Blackburn, RN, Lee J. Frazin, MD Journal of Vascular Surgery Volume 24, Issue 5, Pages 834-842 (November 1996) DOI: 10.1016/S0741-5214(96)70020-4 Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Relationship of stomach to abdominal aorta and its branches. Abdominal aorta, renal arteries, and mesenteric arteries lie immediately posterior to stomach and pancreas. B, Relationship of transgastric ultrasound transducer to abdominal aorta and its branches. Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Relationship of stomach to abdominal aorta and its branches. Abdominal aorta, renal arteries, and mesenteric arteries lie immediately posterior to stomach and pancreas. B, Relationship of transgastric ultrasound transducer to abdominal aorta and its branches. Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, CT scan of abdominal aortic aneurysm demonstrating rim of calcification within intraluminal thrombus. Note intraluminal calcification within aneurysm thrombus (open arrow) opposite aortic lumen. B, Transabdominal ultrasonography in same patient confirms large aortic aneurysm, but images of details of intraluminal thrombus are not obtained. C, Transgastric ultrasonography confirms calcification within intraluminal thrombus (open arrow). Note right and left sides on transgastric ultrasound images are oriented as if looking from head toward feet. Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, CT scan of abdominal aortic aneurysm demonstrating rim of calcification within intraluminal thrombus. Note intraluminal calcification within aneurysm thrombus (open arrow) opposite aortic lumen. B, Transabdominal ultrasonography in same patient confirms large aortic aneurysm, but images of details of intraluminal thrombus are not obtained. C, Transgastric ultrasonography confirms calcification within intraluminal thrombus (open arrow). Note right and left sides on transgastric ultrasound images are oriented as if looking from head toward feet. Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, CT scan of abdominal aortic aneurysm demonstrating rim of calcification within intraluminal thrombus. Note intraluminal calcification within aneurysm thrombus (open arrow) opposite aortic lumen. B, Transabdominal ultrasonography in same patient confirms large aortic aneurysm, but images of details of intraluminal thrombus are not obtained. C, Transgastric ultrasonography confirms calcification within intraluminal thrombus (open arrow). Note right and left sides on transgastric ultrasound images are oriented as if looking from head toward feet. Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, CT scan of abdominal aortic aneurysm with penetrating posterior ulcer. CT scan demonstrates intraluminal calcification, but posterior ulcer is not seen clearly. B, Transabdominal ultrasonography in same patients shows large aneurysm but no evidence of ulcer. C, Transgastric ultrasonography (black and white image) reveals posterior ulcer (arrow). D, Transgastric ultrasonography (color flow image) demonstrates blood flow within this posterior ulcer (arrow). Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, CT scan of abdominal aortic aneurysm with penetrating posterior ulcer. CT scan demonstrates intraluminal calcification, but posterior ulcer is not seen clearly. B, Transabdominal ultrasonography in same patients shows large aneurysm but no evidence of ulcer. C, Transgastric ultrasonography (black and white image) reveals posterior ulcer (arrow). D, Transgastric ultrasonography (color flow image) demonstrates blood flow within this posterior ulcer (arrow). Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, CT scan of abdominal aortic aneurysm with penetrating posterior ulcer. CT scan demonstrates intraluminal calcification, but posterior ulcer is not seen clearly. B, Transabdominal ultrasonography in same patients shows large aneurysm but no evidence of ulcer. C, Transgastric ultrasonography (black and white image) reveals posterior ulcer (arrow). D, Transgastric ultrasonography (color flow image) demonstrates blood flow within this posterior ulcer (arrow). Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, CT scan of abdominal aortic aneurysm with penetrating posterior ulcer. CT scan demonstrates intraluminal calcification, but posterior ulcer is not seen clearly. B, Transabdominal ultrasonography in same patients shows large aneurysm but no evidence of ulcer. C, Transgastric ultrasonography (black and white image) reveals posterior ulcer (arrow). D, Transgastric ultrasonography (color flow image) demonstrates blood flow within this posterior ulcer (arrow). Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 A, Arteriography in patient with left renal artery stenosis and abdominal aortic aneurysm reveals high-grade (>90% diameter) left renal artery stenosis (arrow). B, Transabdominal ultrasound image demonstrates left renal artery (white pixel), but study was nondiagnostic for left renal artery stenosis because of difficulty in obtaining velocity measurements with associated aortic aneurysm (arrow). Image of renal artery plaque was not obtained. C, Transgastric ultrasonography reveals obstructive plaque narrowing origin of left renal artery (arrow). Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 A, Arteriography in patient with left renal artery stenosis and abdominal aortic aneurysm reveals high-grade (>90% diameter) left renal artery stenosis (arrow). B, Transabdominal ultrasound image demonstrates left renal artery (white pixel), but study was nondiagnostic for left renal artery stenosis because of difficulty in obtaining velocity measurements with associated aortic aneurysm (arrow). Image of renal artery plaque was not obtained. C, Transgastric ultrasonography reveals obstructive plaque narrowing origin of left renal artery (arrow). Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 A, Arteriography in patient with left renal artery stenosis and abdominal aortic aneurysm reveals high-grade (>90% diameter) left renal artery stenosis (arrow). B, Transabdominal ultrasound image demonstrates left renal artery (white pixel), but study was nondiagnostic for left renal artery stenosis because of difficulty in obtaining velocity measurements with associated aortic aneurysm (arrow). Image of renal artery plaque was not obtained. C, Transgastric ultrasonography reveals obstructive plaque narrowing origin of left renal artery (arrow). Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Renal artery velocity measurements with transgastric vascular ultrasonography were obtained by placing ultrasound probe opposite from renal artery to be imaged. Blood flow velocity at origin of this normal right renal artery was measured at 0-degree angle of Doppler insonation by placing transgastric ultrasound probe in line with left anterolateral wall of aorta. Renal artery blood flow (moving away from transducer) is represented by Doppler signals below baseline. Doppler signals above baseline represent blood flow in abdominal aorta recorded at junction of right renal artery and abdominal aorta. Journal of Vascular Surgery 1996 24, 834-842DOI: (10.1016/S0741-5214(96)70020-4) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions