Novelli Marco, Righi Daniele, Pilato Alida
Struttura Complessa Medicina Interna, Ospedale ex Mauriziano Lanzo Torinese, ASL TO4, Torino.
Recenti Prog Med. 2012 Sep;103(9):337-47. doi: 10.1701/1136.12528.
Diagnostic and therapeutic percutaneous endovascular procedures have become more and more common in recent years, and so also the number of local complications has increased. After such procedures a simple clinical examination may show the presence of an inguinal mass, but does not permit a diagnosis, while Color Doppler and Duplex Scanner can make a differential diagnosis between hematoma, pseudoaneurysm, arteriovenous fistula or other disease. Color Doppler is ubiquitously used to diagnose such complications as it offers a low-cost, easy-to-use method, only minimally uncomfortable for the patient. This ultrasound system can provide both anatomic and haemodynamic information. Our study highlights the diagnostic possibilities offered by the Color Doppler and Duplex Scanner and details, using many illustrations and examples, how the most common complications such as hematoma, pseudoaneurysm, arteriovenous fistula and thrombosis are imaged. Hematoma appears as a hypoechogenic zone, with no color inside, as flow is not present. Pseudoaneurysms, unlike hematoma, maintain a connection with an injured blood vessel, and so they show blood flow both inside the lesion and in the communicating channel, with a typical pattern. The arteriovenous fistula is a vascular channel created, after a percutaneous procedure, between an artery and an adjacent vein that have both been damaged. An endovascular thrombus is directly shown as a luminal defect of flow. Other less common complications are discussed and illustrated.