RadioGraphics, Vol 14, 239-253, Copyright © 1994 by Radiological Society of North America
Duplex and color Doppler sonography of complications after percutaneous interventional vascular procedures
MC Foshager, DE Finlay, DG Longley and JG Letourneau
Department of Radiology, University of Minnesota Hospital, Minneapolis 55455.
Duplex and color Doppler sonography have proved to be excellent noninvasive
modalities for evaluating complications of percutaneous interventional
vascular procedures. Complications including hematoma, pseudoaneurysm,
arteriovenous fistula, thrombosis, stenosis, and vessel occlusion are
routinely diagnosed with Doppler sonography. Hematomas exhibit variable
echogenicity and internal complexity but never demonstrate internal blood
flow. A pseudoaneurysm is a contained extravasation of blood that, unlike a
hematoma, maintains a patent vascular connection with the injured vessel.
Puncture-related arteriovenous fistulas are false vascular channels between
an adjacent artery and vein that demonstrate low-resistance arterial
signal, high- velocity venous outflow, and variable flow patterns within
themselves. Narrowing in a stent demonstrates high-velocity turbulent flow
with conventional Doppler and color aliasing with color Doppler techniques.
Thrombus can be seen directly as a mural-based or luminal defect; however,
it is often alterations in color flow dynamics, waveform characteristics,
and flow velocities that permit conclusive diagnosis. Early experience in
evaluation of stent stenosis in patients with transjugular intrahepatic
portosystemic shunts suggests that low- velocity shunt flow indicates
stenosis, likely related to the presence of low-resistance collateral
pathways. Familiarity with both the interventional procedures and their
possible complications facilitates prompt diagnosis and treatment.
