Dr Cacovean Adrian

Doppler vascular ultrasound

It is an ultrasound like none other. In fact it is still an ultrasound, with features that make it something special.
It is increasingly based on the principle of sonar, the detection in water of objects that might strike a marine vessel (ship or submarine) or bound to hit that vessel and threatens it.

Unlike other ultrasound, the Doppler vascular provides medical information not only on morphology (shape) of the structures examined (particularly blood vessels), but functional data, the impact of these changes (usually clogging and / or flow backwards or with changed parameters more slowly developing anatomical features or cure errors) and may provide a specialist very useful information to organize the treatment with drugs or surgically, justifying it and being a neutral test for the medical act.

Usually these investigations, which may confirm, refute, justify, monitor, and certify a medical or surgical treatment is performed by a doctor who only deals with this investigation. The ultrasound vascular doctor, usually a cardiologist, but can also be a specialist in medical imaging, internist, in other countries, only specialized in vascular ultrasound, has the opportunity, usually to verify the actual appearance, intraoperative, of parameters and images measured in the ultrasound.

Doppler vascular ultrasound gives your doctor the image of the structures investigated, but also the way how blood flows through the vessel examined, the blood flow parameters and the effect of pathological anatomic changes of the vessels on blood flow through the vessels.

Vascular Doppler ultrasound is performed:

• targeted, on arteries or veins and segments (legs, upper limbs, carotid and vertebral, abdominal aorta, thoracic aorta, iliac, renal, superior cava, inferior cava, visceral branches of abdominal aorta, etc.)
• for diagnosis;
• for therapeutic purposes (varicose sclerosis, endoluminal sclerosis for laser or radio frequency treatment of varicose veins, canulări the central veins or peripheral arteries, etc.)
• to verify the effectiveness of treatment (anticoagulant in thrombosis, restoring arterial flow, etc.) or to determine their duration (the stop of anticoagulation in case of deep vein thrombosis of the legs for example.)
• preoperative, intraoperative, postoperative.

As seen in the previous list (which will be from time to time revised and enlarged), there are many types of vascular ultrasound and many circumstances in which we resort to this investigation. Each of them requires time (about 45 minutes), much longer than the duration of the other ultrasounds (abdominal, cardiac, etc.). I smile with understanding each time I examined a patient who comes on his own initiative and requires a vascular Doppler ultrasound (an „eco Doppler”) and when I ask where exactly he wants to do the ultrasound (in arteries or veins , legs or head, etc.), he says he wants one for all vessels.

Then I am forced to utter the story above and to say that overall vascular ultrasound will be very long, will last all day and all night, probably will end the next day and will cost a lot. Then these patients accept that vascular ultrasound should be performed at the direction of a physician, with a particular purpose and if the patient does not come with a reference from another doctor, then more useful is an examination of the specialist and then, if necessary, for some reason found by the examining doctor, an ultrasound can be done with purpose, targeted to a particular segment considered to have problems.

As above, for Doppler vascular ultrasound there should be a reference from a doctor, to have specified a diagnosis, reason, purpose and segment examined anatomically, in which case the ultrasound programming from the initiative of the patient obliges me to give explanations that may be sometimes longer than the above to be understood that a prior consultation (by me or another doctor) may be more useful and certainly cheaper than an ultrasound examination performed at the request of the patient. Most times, after consultation, the ultrasound loses indication or if it finds that it should be done, the area examined and the vessel type differs from the patient’s original request.

Moreover, I add that the vascular ultrasound is registered as a description of anatomic and functional parameters, and sometimes the screen printed images, which are less understood even by physicians and patients make little association with other imaging examinations (radiographs, arteriography, cardiac catheterization, coronarography, CT or MRI exams, etc.) or bio-laboratory (laboratory). If the laboratory physicians have no contact with the patient, the radiologist physician has contact with the patient during the examination or at all when the patient comes for the result (usually the next day), the vascular ultrasound physician releases the result immediately and the patient may be confused that the Doppler vascular ultrasound is an imaging examination and not a consultation and eager to learn "what about", how serious are the findings, the treatment and prognosis.

In reality, the Doppler vascular ultrasound is an imaging and paraclinical examination and the findings are interpreted by the treating physician, which establishes what to do subject to the other data he has about you and under which you will be sent to the ultrasound for which you came .

For me, cardiovascular surgeon, the Doppler vascular ultrasound offers me the opportunity to examine patients that I treat through ultrasound (surgical or medical). If at first I had some fear of making a wrong ultrasound diagnosis, in time have gained safety by checking intraoperatively the diagnosis and are now I am performing bypass based solely on the ultrasound taken by me.

The Doppler ultrasound is an extremely useful method of investigation, harmful and accessible at any time for vascular diseases. I thank Mrs. Professor Doctor Ileana Arsenescu for the quality of the course and high standards required for competence in Doppler vascular ultrasound and my wife for the support in the effort to obtain this competence.

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