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 Figure 8 – Preoperative assessment of abdominal aortic aneurysm (AAA). A – Neck diameter at the lowest renal artery level B – Neck diameter 15 mm below the origin of the lowest renal artery C – Longitudinal extension of the proximal neck D – Maximum AAA diameter E – Diameter at the bifurcation level (when present) F – Maximum diameter of the common iliac artery G – Diameter of the iliac artery at the hypogastric artery level H – Neck angle with the AAA axis L – Longitudinal extension of AAA • Diagnostic examination: - Report technical difficulties. - Measure the largest diameter of the aorta. - Inform the presence of tortuosities or enlargement of the aorta. - Define the location of the aneurysm: supra-, juxta-, or infrarenal. - Describe the anatomical shape of the aneurysm: saccular, fusiform, or other. - Inform the presence or absence of wall thrombi, the intraluminal diameter, and signs of rupture. • Additional information for the preoperative examination: - Diameters: ○ Neck in the lowest renal artery plane. ○ Neck 15 mm below the origin of the lowest renal artery. ○ Maximum AAA – AP transverse plane (ITI or OTO). ○ Bifurcation plane (when present). ○ Both common iliac arteries. ○ Iliac artery bifurcation. - Longitudinal extension of the proximal neck. - Neck angle with aneurysm axis. - Longitudinal extension of AAA. 3.2. Aortoiliac Atherosclerotic Disease VUS allows the identification, localization, and anatomic extension of atherosclerotic lesions, and evaluates the aortic wall to register not only the presence of atherosclerotic lesion but of ulceration, calcification, thrombus, dissection, and dilation. When performed by trained and experienced professionals, this technique has good diagnostic accuracy for aortoiliac atherosclerotic disease, with 86% sensitivity and 97% specificity for lesions > 50% stenosis. 34 3.2.1. Clinical Indications for Venous Ultrasound in Cases of Aortoiliac Atherosclerotic Disease • Symptoms of acute ischemia (distal embolism) and intermittent claudication with decreased or absent femoral pulse, gluteal claudication, erectile dysfunction, and pain at rest. • Clinical signs such as abdominal bruit and reduced ankle-brachial index. • Prior VUS showing abnormalities in the velocity curve pattern of femoral arteries. • Follow-up of grafts and endoprostheses for the treatment of aortoiliac obstruction. • Suspected diagnosis of aortic dissection. • Suspected diagnosis of arteritis. 823