Biomedical subjects

H Hoeneveld

Publications and source records attributed to H Hoeneveld.

13 recordsLinked to original sources

PubMed1994

The development of valvular incompetence after deep vein thrombosis: a follow-up study with duplex scanning.

PURPOSE: Duplex ultrasonography with distal cuff deflation was used to establish the physiologic reflux duration in different segments of the deep venous system in healthy individuals, and to document the occurrence of deep vein valve incompetence in patients after deep vein thrombosis (DVT). METHODS: Two hundred fifty-two vein segments in 42 legs of 21 healthy individuals and 160 deep vein segments in 27 patients with phlebographically documented DVT were examined with duplex scanning. RESULTS: The duration of reflux in healthy subjects was significantly shorter in distal deep vein segments. Ninety-five percent of the values were less than 0.88, 0.8, 0.8, 0.28, 0.2, and 0.12 seconds, respectively, for the common femoral, superficial femoral, deep femoral, popliteal, and posterior tibial vein (at midcalf and ankle level). The 95 percentile for reflux duration in the superficial venous system was 0.5 seconds for all vein segments, regardless of the location. No significant correlation was found between the reflux peak flow velocity and reflux duration (R = 0.6). The reflux peak flow velocity is therefore not useful as a parameter of the degree of reflux. The patient group was examined with an interval of 18 to 51 months (mean 34 months) after DVT. Forty-five percent of the initially affected segments showed valve incompetence at follow-up (n = 54); only three of 40 segments initially free from thrombus showed pathologic reflux at follow-up (p < 0.01). Reflux durations in most of the incompetent vein segments were two or more times the normal value of reflux duration. The highest prevalence of valve incompetence was found in the superficial femoral and popliteal vein segment (p < 0.01). None of the patients showed valve incompetence at all levels of the deep venous system. A significant (p = 0.04) relation was found between the extent of the initial thrombosis and the number of refluxing vein segments at follow-up, but no correlation was found between the extent of initial thrombosis and the late clinical symptoms (p = 0.16); clinical symptoms could not be related to the number of incompetent vein segments. CONCLUSIONS: Duplex scanning allows a good discrimination between physiologic and abnormal reflux duration and is an important tool in the evaluation of the postthrombotic limb. Early assessment after DVT may have prognostic value in individual patients.

Adult↗

PubMed1993

How can the assessment of the hemodynamic significance of aortoiliac arterial stenosis by duplex scanning be improved? A comparative study with intraarterial pressure measurement.

PURPOSE: The current diagnostic criteria used to assess the severity of stenoses in the aortoiliac arteries by duplex scanning are mainly based on information related to changes in cross-sectional area and are flow independent. Consequently, duplex scanning fails to detect approximately one quarter of hemodynamically significant aortoiliac lesions compared with intraarterial pressure measurements. The aim of this study is to improve the assessment of the hemodynamic significance of aortoiliac lesions by duplex scanning. METHODS: A prospective study in 60 patients was performed in which duplex scanning at rest was compared with intraarterial pressure measurements before and after the administration of papaverine. A simplified Bernoulli equation was used to calculate pressure gradients across stenoses (delta PBern). Two flow-related parameters, the increase in peak systolic velocity (delta PSV) across the stenosis and the end-diastolic velocity at the site of the stenosis, were also measured and compared with intraarterial pressure measurements. RESULTS: delta PBern and delta PSV showed a sensitivity and specificity of 81% and 88%, respectively, for the detection of hemodynamically significant lesions at rest. However, delta PBern could often not give an accurate calculation of the pressure gradient. Receiver operator characteristic analysis showed that a cut-off level for delta PSV in the range of 1.4 to 1.5 m/s was best able to detect significant lesions at rest. The end-diastolic velocity parameter had a limited diagnostic value. CONCLUSION: Although useful in clinical decision making, delta PBern often could not give an accurate calculation of the pressure gradient. delta PSV is a simple and practical spectral analysis parameter to differentiate between significant and insignificant stenoses. This parameter also has the potential to detect hemodynamically less critical lesions if duplex scanning is performed under conditions of increased flow. Further evaluation is needed.

Aorta, Abdominal↗

PubMed1992

Thrombus regression in deep venous thrombosis. Quantification of spontaneous thrombolysis with duplex scanning.

BACKGROUND: Thrombus regression in heparin-treated, acute deep venous thrombosis of the lower extremity is poorly documented in the literature; different rates of thrombus resolution and recanalization are reported. METHODS AND RESULTS: In a prospective follow-up study, duplex scanning was used to evaluate the thrombus regression in patients with documented acute femoropopliteal thrombosis. Eighty vein segments in 20 legs of 18 patients were subjected to repeat duplex scans at 1, 3, 6, 12, and 26 weeks after diagnosis; 49 segments showed thrombus at diagnosis. The popliteal vein showed the highest thrombus load at diagnosis, followed in descending order by the superficial femoral, profunda femoris, and common femoral vein segments (p less than 0.001). Thrombus regression was significant (p less than 0.001) in all segments and proceeded at an exponential rate that was equal in the different vein segments of the upper leg. Both thrombus resolution and recanalization appeared to be a function of the initial thrombus load and could not be related to individual vein segments. Recanalization was seen in 23 of 31 initially occluded segments and occurred within the first 6 weeks after diagnosis in 20 of 23 segments. Extension of thrombus despite anticoagulant therapy was observed in 15 vein segments and was not related to the initial thrombosis score (p = 0.1) or individual vein segments (p = 0.23). Thrombus extension in seven patients with prethrombotic conditions was not different (p = 0.9) from the other patients. CONCLUSIONS: Duplex scanning is an important noninvasive tool to quantify thrombus regression in acute deep venous thrombosis in detail without unnecessary discomfort to the patient.

Female↗

PubMed1991

Value of duplex scanning compared with angiography and pressure measurement in the assessment of aortoiliac arterial lesions.

To detect haemodynamically significant lesions in the aortoiliac arteries, invasive tests such as angiography and intra-arterial pressure measurement (IAPM) are considered valuable diagnostic tools. The value of duplex scanning as a direct non-invasive examination technique was prospectively compared with intra-arterial digital subtraction angiography (IADSA) and IAPM at rest, and after the administration of papaverine in 60 patients. Excellent agreement, as assessed by the kappa statistic, was shown between duplex scanning and IADSA (kappa = 0.81). A fair agreement was shown between duplex scanning and IAPM (kappa = 0.63), and between IADSA and IAPM (kappa = 0.63). Duplex scanning and IADSA both missed some less haemodynamically critical lesions if IAPM was considered the 'gold standard'. It is concluded that duplex scanning detects haemodynamically significant lesions as effectively as angiography and so may be considered a new and valuable diagnostic tool. IAPM remains necessary to detect some lesions of borderline haemodynamic significance. However, with future developments, duplex scanning has the potential to replace the need even for IAPM.

Angiography, Digital Subtraction↗

PubMed1991

Spectral analysis criteria in duplex scanning of aortoiliac and femoropopliteal arterial disease.

To validate the use of duplex scanning in the detection of lesions in the aortoiliac and femoropopliteal arteries, duplex scanning was prospectively compared to intra-arterial digital subtraction angiography in 61 patients with peripheral atherosclerotic disease. Based on a peak systolic velocity ratio greater than or equal to 2.5 or the absence of a Doppler signal, the overall sensitivity and specificity to detect lesions of greater than or equal to 50% diameter reduction was 84% and 96%, although some segments in the femoropopliteal arteries showed a sensitivity of only 60%-70%. Occlusions were detected with an overall sensitivity of 92% and specificity of 99%. The existence of a bi/triphasic Doppler signal, a window in the systolic spectral waveform and an end diastolic velocity greater than or equal to 60 cm/s has additional value in further grading of stenoses. This study shows that duplex scanning is highly comparable to angiography in the detection greater than or equal to 50% diameter reducing lesions in the aortoiliac arteries. Further evaluation is needed for the femoropopliteal arteries.

Angiography, Digital Subtraction↗

PubMed1991

Duplex scanning in the diagnosis of acute deep vein thrombosis of the lower extremity.

In a prospective study the value of duplex scanning in the diagnosis of acute femoro-popliteal thrombosis was compared to conventional contrast venography (CV) as a gold standard. A total of 126 legs in 117 patients suspected of having deep vein thrombosis (DVT) or pulmonary embolism (PE) were examined with both methods. CV and duplex scanning were diagnostic in 98.5 and 97%, respectively. Femoro-popliteal thrombosis was present in 64 legs (prevalence 54%). The sensitivity and specificity of duplex scanning were 90.6% and 94.6%, respectively. A marked improvement in sensitivity from 83.3 to 97% and overall accuracy from 88.7 to 96% was noticed between the first and second half of the study period. Of the individual duplex criteria in the diagnosis of DVT, abnormal vessel wall compressibility was the most accurate. The Doppler measurements however allow evaluation of venous areas difficult to assess with B-mode and add discrimination between partial or total vein occlusion. Duplex scanning is more accurate compared to CV in grading the anatomical extent of thrombosis. Agreement between venography and duplex scanning was found in 75% of the vein segments, in about 20% CV suggested more thrombus formation compared to duplex scanning. Thrombus in the deep femoral vein was documented by duplex scanning in 24 patients including two cases of isolated deep femoral vein thrombosis. Venography failed to visualise the deep femoral vein with sufficient diagnostic accuracy in 88% of the patients vs. 8.5% with duplex scanning. Duplex scanning is an accurate non-invasive test in the diagnosis of acute femoro-popliteal thrombosis and superior to CV in the detection of non-occlusive and deep femoral vein thrombosis.

Acute Disease↗

PubMed1990

The correlation between clinical and duplex ultrasound parameters and the development of complications in arterio-venous fistulae for haemodialysis.

In a 2 year prospective study of the fate of arterio-venous haemodialysis fistulae, the influence of several clinical and non-invasive measured variables in 90 patients on maintenance haemodialysis was evaluated. A total of 58 Brescia/Cimino fistulae, 30 graft fistulae and two elbow fistulae were investigated by means of Duplex ultrasound scanning. Sixty-two out of these 90 patients had no problems with their AV fistulae, 28 developed 29 complications, including poor flow (six), thrombosis (seven), venous hypertension (eight), false aneurysm formation (four), distal ischaemia (two) and puncture problems (two). Univariate statistical analysis was performed on a number of clinical variables including diabetes, previous access surgery, type of fistula, duration of functioning fistula, congestive heart failure, peripheral arterial disease, age and sex. Results indicated that the type of fistula, previous access surgery, congestive heart failure and sex were significantly correlated to the development of poor flow and thrombosis (flow-related complications). Measurement of the maximal systolic frequency, end-diastolic frequency and the frequency ratio in the brachial artery Doppler spectrum, was of prognostic value in discriminating between non-complicated fistulae and those which developed flow-related complications. The total number of fistula stenoses (greater than 50% diameter reduction), detected by the Duplex scan, also correlated with the rate of thrombosis and poor flow. The presence of peripheral arterial disease and the number of stenoses in the efferent veins were of predictive value for the development of venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

The potential of duplex scanning to replace aorto-iliac and femoro-popliteal angiography.

The ability of duplex scanning to assess haemodynamically significant lesions in the aorto-iliac and femoro-popliteal arteries was studied. Duplex scanning was prospectively and independently compared to intra-arterial digital subtraction angiography (ia. DSA) of the aorto-iliac and femoro-popliteal arteries and intra-arterial pressure measurements of the aorto-iliac tract before and after the administration of papaverine. In 40 patients 629 arterial segments were evaluated. A greater than 150% increase in peak systolic velocity had a sensitivity of 92% and a specificity of 98% in detecting greater than 50% diameter reducing lesions in the aorto-iliac arteries as compared to ia. DSA. The numbers for the femoro-popliteal arteries are 88% and 98% respectively. Detection of occlusion in the aorto-iliac arteries had a sensitivity and specificity of 100% and in the femoro-popliteal arteries 90% and 100% respectively. There was a poorer correlation between intra-arterial pressure measurements and duplex scanning or ia. DSA as compared to the correlation between ia. DSA and duplex scanning. Retrospective spectral analysis showed that an end diastolic velocity (EDV) of greater than 40 cm/s seems to be a valuable parameter to differentiate between 50% to 74% and 75% to 99% diameter reduction. It is concluded that duplex scanning can reliably differentiate between haemodynamically significant and insignificant lesions in the aorto-iliac and femoro-popliteal arteries and has the potential to replace angiography.

Angiography↗

PubMed1989

Duplex ultrasound scanning in the assessment of arteriovenous fistulas created for hemodialysis access: comparison with digital subtraction angiography.

The results of duplex ultrasound scanning for the diagnosis of stenoses in Brescia-Cimino arteriovenous fistulas and graft arteriovenous fistulas created for hemodialysis access are reported. Quantitative Doppler spectrum analysis of 64 arteriovenous fistulas was correlated with the outcome of digital subtraction angiography. The best Doppler parameter for the detection of a stenosis was the peak systolic frequency. In graft arteriovenous fistulas the use of this parameter resulted in a diagnostic accuracy of 86%, a sensitivity of 92%, and a specificity of 84% in the detection of stenoses. In Brescia-Cimino arteriovenous fistulas the diagnosis of anastomotic stenoses was possible with a diagnostic accuracy of 81%, a sensitivity of 79%, and a specificity of 84%. Measurement of peak systolic frequency ratios or end-diastolic frequencies had no additional diagnostic value for the detection of stenoses. The diagnosis of efferent vein stenoses was very accurate with duplex investigation (accuracy 96%, sensitivity 95%, and a specificity of 97%. We conclude that duplex scanning is a promising noninvasive method for the diagnosis of stenoses in arteriovenous fistulas created for hemodialysis access.

Adult↗

PubMed1988

Benefits of carotid patching: a randomized study.

Advocates of carotid artery patching claim a reduced incidence of recurrent stenosis after endarterectomy. A prospective study was undertaken to determine its value with random selection between primary closure and saphenous vein patching. A consecutive series of 129 carotid endarterectomies was evaluated by duplex scanning at 3, 6, and 12 months after operation. Intravenous digital subtraction angiography (DSA) was performed in the first postoperative days for control of the surgical technique and after 1 year to serve as a reference for the duplex scanning. Sixty-two patients were selected to have primary closure and 67 were chosen for the patching technique. Both groups were identical with regard to risk factors (mean age 63 years, 74% were men, 57% had hypertension, 41% had coronary disease, 37% had peripheral arterial disease, and 9% had diabetes mellitus), side of operation (55% left), symptoms (18% were asymptomatic), and postoperative DSA (81% were normal, 17% had residual lesions, and 2% had occlusions). A complete 1-year follow-up was obtained in 105 cases (81%); duplex scanning showed recurrent stenosis of more than 50% in 12 cases (11%). This was significantly higher after primary closure (10 of 48 patients = 21%) compared with patch closure (2 of 57 = 3.5%; p = 0.006) and also in women (6 of 25 = 24%) compared with men (6 of 80 = 7.5%; p = 0.03). Recurrent stenosis was present in 6 of 11 women with primary closure (55%), 4 of 37 men with primary closure (11%), 2 of 43 men with patching (5%), and none of 14 women with patch closure (0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗

PubMed1987

Residual lesions and early recurrent stenosis after carotid endarterectomy. A serial follow-up study with duplex scanning and intravenous digital subtraction angiography.

In 109 internal carotid endarterectomies a complete serial follow-up study with ultrasonic duplex scanning was performed at 3, 6, and 12 months after operation. A duplex scan was also performed 2 years postoperatively in 75 cases. Moreover, the state of the endarterectomized carotid bifurcations was documented by intravenous digital subtraction angiography during hospitalization and at 12 months. At 3, 6, 12, and 24 months after operation the rate of significant recurrent stenosis was 6%, 12%, 6%, and 8%, respectively. Approximately half of the arteries with a significant stenosis at 1 year already demonstrated this lesion with intravenous digital subtraction angiography performed 1 week after operation. Persistent significant recurrent stenosis in the remaining arteries was probably the result of excessive myointimal proliferation. This occurred with a higher frequency in women (14.8%) than in men (4.1%). The greater number of the arteries with minimally or mildly disturbed spectral waveforms 3 months after endarterectomy spontaneously normalized or remained stable during the follow-up period. On the other hand, 40% of the arteries with a significant stenosis (diameter reduction of 50% or more) at the three-month control follow-up period increased to a more severe degree of stenosis during the first postoperative year. Most of the operated arteries did not significantly change during the second year.

Carotid Artery Diseases↗

PubMed1982

The accuracy of ultrasonic duplex scanning in carotid artery disease.

Ultrasonic duplex scanning of the internal carotid artery is highly accurate in the detection of disease as expressed in its sensitivity of 0.97 and specificity of 0.82 for haemodynamic significant lesions. For the detection of obstructions of 20% or over, these parameters are 0.94 and 0.77 respectively. The most striking problem is the poor classification of normal vessels and those with minor lesions. The duplex scanning overestimates the degree of disease in these cases. For the external carotid artery the method differentiates reasonably well between non-haemodynamic and haemodynamic significant lesions.

Angiography↗

PubMedDate not supplied

Ultrasonic duplex scanning in atherosclerotic disease of the innominate, subclavian and vertebral arteries. A comparative study with angiography.

Ultrasonic duplex scanning of the vertebral artery has a sensitivity of 0.80 and a specificity of 0.83 for the detection of an obstructive lesion of 50% or more at the site of the ostium. For the subclavian arteries these values are respectively 0.73 and 0.91. For both vessels the test has a very high negative predictive value of respectively 0.96 and 0.97. Therefore duplex ultrasound scanning is a reliable test in screening patients suspected of multi-level atherosclerotic disease of the extracranial cerebral vessels. The problem remains in classifying the degree of stenosis. In the case of the vertebral artery the sample volume of the pulsed Doppler is usually too large in relation to the vessel diameter. In the case of the subclavian and innominate artery one of the main problems is the range of the pulsed Doppler system. A subclavian steal syndrome is easily diagnosed without any special test.

Angiography↗