ABC | Volume 112, Nº6, June 2019

Statement Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(6):809-849 Content 1. Introduction And Equipment .........................................................811 1.1. Introduction ......................................................................................811 1.2. Equipment ........................................................................................812 1.2.1. Machine ........................................................................................812 1.2.2. Applications (Software) .................................................................812 1.2.3. Multi-frequency or Broadband Transducers .................................812 1.2.3.1. Image Orientation ......................................................................812 2. Carotid and Vertebral Arteries .......................................................812 2.1. Intima-media Thickness and Detection of Carotid Artery Plaques for Cardiovascular Risk Assessment .............................................................812 2.2. Ultrasound Definition of Intima-media Thickness and Carotid Plaque .....................................................................................................813 2.2.1. Indications ....................................................................................813 2.2.2. Measurement Protocol .................................................................813 2.2.3. Interpretation of Results ...............................................................813 2.2.4. How to Prepare a Report ..............................................................813 2.3. Morphological Evaluation of Carotid Atherosclerotic Plaques ............814 2.4. Quantification of Carotid Artery Stenosis ..........................................814 2.4.1. Measurement Techniques to Quantify Stenosis ...........................815 2.4.1.1. Quantification of Carotid Stenosis with Hemodynamic Parameters ..............................................................................................815 2.4.1.2. Quantification of Carotid Stenosis with Anatomic Parameters .......817 2.4.2. Circumstances that Can Change the Measurement of Flow Velocities and Anatomic Evaluation ........................................................817 2.4.3. Report Description .......................................................................817 2.5. Ultrasound Assessment After Carotid Intervention ............................817 2.6. Ultrasound Evaluation of Vertebral Arteries .......................................819 2.6.1. Methodology to Perform the Examination ....................................819 2.6.2. Quantification of Stenosis ............................................................820 3. Abdominal Aorta and Branches ....................................................820 3.1. Abdominal Aortic Aneurysm .............................................................820 3.1.1. General Considerations ................................................................820 3.1.2. Clinical Indications .......................................................................821 3.1.3. Examination Instructions and Protocols .......................................821 3.1.4. Examination Protocol for Abdominal Aortic Aneurysm According to Recommendations from the Department of Cardiovascular Imaging ......821 3.2. Aortoiliac Atherosclerotic Disease .....................................................823 3.2.1. Clinical Indications for Venous Ultrasound in Cases of Aortoiliac Atherosclerotic Disease ..........................................................................823 3.2.2. Examination Protocol for Aortoiliac Atherosclerotic Disease According to DCI Recommendations .....................................................824 3.2.2.1. Diagnostic Criteria .....................................................................824 3.3. Mesenteric Arteries ...........................................................................824 3.3.1. General Considerations ................................................................824 3.3.2. Clinical Indications .......................................................................825 3.3.3. Examination Preparation and General Protocol ...........................825 3.3.4. Essential Information to Include in the Medical Report ...............826 3.3.5. Examination Limitations ...............................................................826 3.4. Renal Arteries ...................................................................................826 3.4.1. General Considerations ................................................................826 3.4.2. Examination Protocol ....................................................................827 3.4.3. Diagnostic Criteria for Renal Artery Stenosis ...............................827 3.4.4. Limitations of the Renal Artery Study ...........................................828 3.4.5. Essential Information to Include in the Medical Report ...............828 4. Lower-Limb Arteries ........................................................................828 4.1. Clinical Indications ............................................................................828 4.2. Examination Protocol ........................................................................828 4.3. Diagnostic Criteria ............................................................................828 4.4. Essential Information to Include in the Medical Report .....................829 4.5. General Limitations of the Peripheral Artery Ultrasound .................829 5. Arteriovenous Fistulas for Hemodialysis .....................................829 5.1. Introduction ......................................................................................829 5.2. Examination Indications ....................................................................831 5.3. Technique .........................................................................................831 5.4. Diagnostic Criteria ............................................................................831 5.4.1. Protocol to Create Arteriovenous Fistulas for Hemodialysis ........831 5.4.2. Protocol after Procedure ...............................................................832 5.4.3. Causes and Types of Failures (Autogenous and Prosthetic) .........833 5.4.4. Examination Limitations ...............................................................833 5.4.5. Suggestions to Elaborate the Report and Conclusion ...................833 6. Deep Venous Thrombosis ..............................................................834 6.1. Introduction ......................................................................................834 6.2. Post-Thrombotic Syndrome ...............................................................835 6.2.1. Deep Venous Thrombosis Diagnosis ............................................835 6.2.2. Vascular Ultrasound ......................................................................836 6.3. Rethrombosis ...................................................................................837 6.4. Examination Technique .....................................................................837 6.4.1. Transducers ...................................................................................838 6.4.2. Information for the Report ...........................................................838 7. Transcranial Doppler .......................................................................838 7.1. Types of Transcranial Doppler ...........................................................838 7.2. Examination Technique and Protocol ................................................838 7.3. Limitations of Transcranial Color Doppler ..........................................840 7.3.1. Essential Information to Include in Transcranial Doppler Reports ....................................................................................................840 8. Contrast in Vascular Ultrasound ....................................................841 8.1. Properties of Ultrasound Contrast Agents .........................................842 8.2. Technical Aspects that Influence the Acquisition of Contrast Images ....................................................................................................842 8.2.1. Mechanical Index ..........................................................................842 8.2.2. Image Gain ...................................................................................842 8.2.3. Contrast Level ...............................................................................842 8.3. Indications for Contrast in Vascular Ultrasound .................................843 8.4. Preparation, Application, and Dose of Microbubble Contrast ..........843 8.5. Basic Protocol for Vascular Ultrasound with Microbubble Contrast ......844 8.6. Limitations of the Use of Contrast in Vascular Ultrasound .................844 Acknowledgments ...............................................................................844 References ............................................................................................844 1. Introduction and Equipment 1.1. Introduction The use of ultrasound (US) in Medicine started in the decade of 1940 and, since then, it has played a significant role in the diagnosis of cardiovascular diseases (CVD). It is a diverse technology that follows the physical principles of propagation of US waves in different media. Due to its broad applicability, relatively low-cost, and reproducibility, US has a secure place in diagnostic aid. Members of the Department of Cardiovascular Imaging (DCI) – experts in vascular ultrasound (VUS) – prepared this guideline to indicate the best use of this technique, according to recommendations from the current medical literature. We included the main aspects related to equipment components, software, transducers, and their evolution since the last guideline, and addressed the most relevant topics in the field of diagnosis of vascular diseases. The foundation behind using VUS to diagnose important pathologies, such as carotid atherosclerotic disease, diseases in vertebral arteries, abdominal aorta and its branches, was 811