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 1. Freire CM, AlcântaraML, Santos SN, Amaral SI, VelosoO, Porto CLL, et al. Recomendações para quantificação pelo US da doença aterosclerótica das artérias carótidas e vertebrais: grupo de trabalho do departamento de imagem cardiovascular da Sociedade Brasileira de Cardiologia – DIC – SBC. Arq Bras Cardiol: Imagem cardiovasc. 2015;28(número especial):e1-64. 2. Alcântara ML, Santos SN, Freire CM, Amaral SI, Veloso O, Porto CL, et al. Recomendações para avaliação ultrassonográfica da aorta abdominal e ramos: grupo de trabalho do departamento de imagem cardiovascular da Sociedade Brasileira de Cardiologia – DIC – SBC. Arq Bras Cardiol: Imagem cardiovasc. 2016;29(nº especial):e1-68. 3. Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis-- Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003;229(2):340-6. 4. Oates CP, Naylor AR, Hartshorne T, Charles SM, Fail T, Humphries K, et al. Joint recommendations for reporting carotid ultrasound investigations in the United Kingdom. Eur J Vasc Endovasc Surg. 2009;37(3):251-61. 5. World Health Organization (WHO). Noncommunicable diseases [Cited in: 2018 Jun 1] Available in: http://www.who.int/mediacentre/factsheets/ fs355/en. 6. Sposito AC, Caramelli B, Fonseca FA, Bertolami MC, Afiune Neto A, Souza AD, et al., Sociedade Brasileira de Cardiologia. IV Brazilian Guideline for Dyslipidemia and Atherosclerosis prevention: Department of Atherosclerosis of Brazilian Society of Cardiology. Arq Bras Cardiol. 2007;88(Suppl 1):2-19. 7. Xavier HT, Izar MC, Faria Neto Jr, Assad MH, Rocha VZ, Sposito AC, et al., Sociedade Brasileira de Cradiologia. V Brazilian Guidelines on Dyslipidemias and Prevention of Atherosclerosis. Arq Bras Cardiol. 2013;101(4 Suppl 1):1-20. 8. Faludi AA, Izar MC, Saraiva JF, Chacra AP, Bianco HT, Afiune AN, et al. Sociedade Brasileira de Cardiologia. Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose – 2017. Arq Bras Cardiol. 2017;109(2 Suppl 1):1-76. 9. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290-6. 10. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al., American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93-111;quiz 89-90. 11. Santos RD, Gagliardi AC, Xavier HT, Casella Filho A, Araujo DB, Cesena FY, et al., Sociedade Brasileira de Cardiologia. First Brazilian guidelines for familial hypercholesterolemia. ArqBras Cardiol. 2012;99(2 Suppl 2):1-28. 12. Simao AF, Precoma DB, Andrade JP, Correa FH, Saraiva JF, Oliveira GM, et al., Sociedade Brasileira de Cardiologia. I Brazilian Guidelines for cardiovascular prevention. Arq Bras Cardiol. 2013;101(6 Suppl 2):1-63. 13. Santos IS, Bittencourt MS, Oliveira IR, Souza AG, Meireles DP, Rundek T, et al. Carotid intima-media thickness value distributions in The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Atherosclerosis. 2014;237(1):227-35. 14. Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age References 8.5. Basic Protocol for Vascular Ultrasound with Microbubble Contrast After defining the indication for microbubble contrast in VUS examination, follow the mandatory basic routine: • Repeat and record the standard CDUS examination of the organ of interest • Secure venous access for injection of contrast solution with microbubbles (peripheral vein puncture or deep vein already in use) • Prepare the contrast solution with microbubbles (SonoVue ® ) following the manufacturer’s instructions • Activate the specific image component for contrast in US equipment; if there is no specific software, adjust MI (< 0.6 and the closest possible to 0.1), image gain (darken the background), and choose the appropriate windows to reduce the depth of the target-organ under study • Administer the contrast solution, make adjustments to reduce excessive enhancement, and record digital images (videos) for 10 to 40 seconds after the initial bolus injection; in specific longer examinations, record the necessary videos during the procedure (which can reach 5 to 8 minutes) for later analysis. Note : analysis of examination with microbubble contrast is fundamentally dynamic and the duration of the study is short due to the fast destruction of microbubbles by US waves, even when using very low MI. Thus, recording it in digital media is essential for later processing and careful review of images, ensuring a safe diagnosis and permanent storage of results. 8.6. Limitations of the Use of Contrast in Vascular Ultrasound • Inexperience of the examiner (proper training in ultrasound with contrast is crucial for an effective and safe diagnosis). • Equipment without a specific software for image with contrast makes it difficult (but not impossible) to conduct a conclusive examination. • Access to microbubble contrast in units of the Brazilian public health system. • Complete lack of “window” that allows US transmission to the organ of interest (rare). • Hypersensitivity to microbubble contrast (rare). Acknowledgments To the authors and the US Doppler Escola de Ensino Presencial e a Distância for the images. To Rodrigo Tonan for the medical ilustrations. 844