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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. May 28, 2015; 7(5): 89-99
Published online May 28, 2015. doi: 10.4329/wjr.v7.i5.89
"To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms
Mustafa Z Mahmoud, Mohammed Al-Saadi, Abdulwahab Abuderman, Khalid S Alzimami, Mohammed Alkhorayef, Babikir Almagli, Abdelmoneim Sulieman
Mustafa Z Mahmoud, Mohammed Al-Saadi, Abdelmoneim Sulieman, Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
Mustafa Z Mahmoud, Basic Medical Sciences Department, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum 11111, Sudan
Abdulwahab Abuderman, Basic Medical Sciences Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
Khalid S Alzimami, Mohammed Alkhorayef, Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
Babikir Almagli, Diagnostic Radiology Department, Faculty of Radiology and Nuclear Medicine, the National Ribat University, Khartoum 1111, Sudan
Author contributions: All authors contributed to this paper.
Supported by College of Applied Medical Sciences Research Center and the Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia.
Conflict-of-interest: The authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Mustafa Z Mahmoud, Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, PO Box 422, Al-Kharj 11942, Saudi Arabia. m.alhassen@sau.edu.sa
Telephone: +966-11-5886331 Fax: +966-11-5453852
Received: October 20, 2014
Peer-review started: October 20, 2014
First decision: December 12, 2014
Revised: March 6, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: May 28, 2015
Abstract

Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of “to-and-fro” waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of “to-and-fro” waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of “to-and-fro” waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and “to-and-fro” flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional “to-and-fro” waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the “to-and-fro” waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.

Keywords: Pseudoaneurysm, To-and-fro waveform, Ultrasonography, Percutaneous thrombin injection, Yin-Yang sign

Core tip: A review of the clinical use of “to-and-fro” waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of “to-and-fro” waveform at DDU also.