Vascular Cases

Ann Marie Kupinski, PhD RVT RDMS FSVUNorth Country Vascular Diagnostics, Inc,

& Albany Medical College, Albany, NY

Clinical Presentation

• 67 year old male• Brachial artery to basilic vein transposition fistula• Difficulty with dialysis with increased venous

pressures

What do you think so far?

• Is the inflow waveform normal?• Is the anastomotic velocity normal?• Is the fistula PSV normal?• Is the fistula flow normal?

Venous Stenosis• Sonolucent

intraluminal material

• Luminal reduction by color flow

• Common at vein bifurcations & valves

• Can result from scarring of puncture sites

Clinical Presentation

• 84 y.o. female • Vertigo • 30 mmHg brachial systolic pressure gradient• Prior CABG

The left CCA

Right CCA and ICA

What is your diagnosis?

A. Distal ICA occlusion

B. Proximal ICA stenosis

C. Innominate artery stenosis/occlusion

D. Right subclavian artery stenosis

The answer is…Innominate artery stenosis/occlusion

Dampened distal innominate waveform

Retrograde right vertebral artery waveform

Clinical Presentation

• 51 year old female• Brachial artery to basilic vein transposition fistula• Increased pressures on dialysis

Clinical Presentation

• 75 year old white male • Bilateral carotid bruits• Right arm weakness• Speech difficulty

What is your diagnosis?

A. Congenital atresia L ICAB. Stenosis/occlusion intracranial L ICAC. String sign L ICAD. Occlusion cervical LICA

The answer is…

A. Congenital atresia L ICAB. Stenosis/occlusion intracranial L ICAC. String sign L ICAD. Occlusion cervical LICA