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Transcutaneous hemotachymetry by ultrasonic Doppler effect is a simple, rapid, atraumatic and inexpensive method for obtaining hemodynamic data from cervical arteries; it is immensely useful for diagnosis of circulatory disorders. The author consider the physical principles of the method, its advantages and its drawbacks. Reproducibility and normal hemodynamic values are discussed.
A study has been carried out using Doppler ultrasonometry on 223 cases, 191 of them suffering from occlusive or stenosing arterial illnesses and 12 with deep massive venous thrombosis, together with 68 control cases. Systolic tensions in the popliteal, dorsalis pedis and posterior tibialis arteries, both at rest and after a conveniently standardized effort, were studied every five minutes over periods of up to thirty minutes. The results are shown grouping these patients according to their clinical features and giving their different responses to the test. Special emphasis is given to cases of badly compensated recent intermittent claudication, diffused atheromatosis, asymtomatic arterial stenosis, thromboangiitis obliterans, Leriche's syndrome and hypertensive ulcers.
40 temporo-sylvian anastomoses were controlled using Doppler ultrasonic examination. The results are compared to post-operative arteriograms. The Doppler examination has proved to be highly accurate when compared to contrast arteriography in the survey of extra-intracranial anastomosis. This non invasive procedure can easily be repeated. However the size of the revascularized area cannot be estimated. The simultaneous isotopic studies of regional cerebral blood flow could provide a means of quantifying the results of the anastomoses.
The Doppler ultrasound diagnosis of carotid artery stenosis (asymetrical systolic and diastolic flows; elevated resistance index: ratio of flow pulse amplitude to systolic and diastolic values; flow reversal in the ophtalmic artery) is compared, in 52 patients, to the clinical, angiographic (40 patients) an surgical findings and to the peroperative measure of intra-arterial pressure and flow (30 patients). Its reliability is proved as a guide for angiographic exploration and for postoperative watching, but it is restricted to great vessels (cervical carotid artery) and is unable to detect ulcerated plate without stenosis.
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The Authors present 38 cases of surgical revascularization for arteriosclerosis obliterans of the lower extremities, operated in Clinica Chirurgica of Ancona during the space of three Years, from 1974-1977. The morphological profile of the sphygmic wave and pressures of occlusion or Travis Winsor's index were studied pre and postoperatively with Doppler ultrasonic flowmeter. The patency of vascular grafts and after thromboendarterectomy was shown by T.W.'s index. With this method, besides establishing a program for postoperative arteriography, a lesser use of the latter was shown.
Results and correlation with arteriographic findings in 25 cases. The methodological criteria essential to the reliability of this examination are described, as well as the special conditions of recording which may influence interpretation. The respective values for systolic and diastolic circulatory rates obtained on ultrasound curves led the authors to classify the results into five groups. There was satisfactory correlation between the latter and the anatomical data provided by arteriography of the vertebral arteries. Such a quantitative approach provides an assessment of the functionally normal or pathological state of the vertebral arteries and of circulatory assymetry.
The author outlines the first results obtained with Doppler investigation in arterial and venous emergencies. He analyzed thereafter the Kakkar test, through which he can detect acute venous more easily than with Doppler. He insists on the difficulty of detecting through either one of these methods, some cases of thrombosis located in the abdominal veins.
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