Duplex
scan in vascular disorders
(Portuguese
PDF version)
Coordinated
by: Ricardo C. R. Moreira
J
Vasc Br 2005;4(1):111
What has
been the greatest advance in the management of vascular diseases over
the past decades? In this reviewer's opinion, it has been Doppler ultrasonography.
Some will disagree, pointing out that the greatest improvement has been
endovascular surgery. However, while the endovascular techniques are
only useful for a minority of patients with arterial disorders, Doppler
ultrasonography (or echo-Doppler, or yet duplex scan) is currently used
on practically all vascular disorders, whether venous or arterial. In
venous disorders, the assessment of varicose veins and the diagnosis
of venous thrombosis are made almost exclusively by the echo-Doppler.
In arterial diseases, arteriography has been replaced by Doppler ultrasonography
for the assessment of occlusive carotid artery diseases, peripheral
aneurysms, and abdominal aorta. Even at arteriography's last redoubt,
occlusive disease of the lower limbs, several experienced surgeons now
use Doppler ultrasonography to make decisions and to choose the surgical
planning. In short, Doppler ultrasound has become the most important
method for the diagnosis and surgical planning of most vascular diseases.
Who was the greatest responsible for the development of Doppler ultrasonography?
Here, practically everyone agrees that it was Prof. D. Eugene Strandness.
In the early 1960's, Prof. Strandness created one of the pioneering
laboratories of non-invasive investigation of vascular disorders at
the University of Washington, in Seattle, USA. There, Prof. Strandness'
team developed successively, over a period of three decades: the Doppler
flowmeter (initially named "Doptone" and used for assessing fetal heartbeats);
the first Doppler pulsed-wave ultrasound devices using; and later the
jewel of the crown: the color-flow duplex scan. Therefore, one can say,
without fear of exaggeration, that Prof. Strandness was the father of
Doppler ultrasound, the creator of the concept of non-invasive vascular
laboratory, and the patriarch of a medical specialty, vascular ultrasonography.
Prof. Strandness passed away on January 7, 2002, at the age of 73 years. However, his legacy as a vascular surgeon and clinical researcher remains alive through numerous scientific papers and books, particularly the book Duplex Scanning in Vascular Disorders, whose translation into Portuguese is the object of this review.
The book
Ecodoppler Colorido nas Doenças Vasculares1, published by Guanabara-Koogan
in 2004 is the translation of the third American issue of Duplex
Scanning in Vascular Disorders, published by Lippincott, William
& Wilkins in 2002. The book has large format (28 x 20 cm) and a quality
presentation, with hard cover and printing in glossy paper. As the title
suggests, the text is enriched by numerous color illustrations of the
ultrasonographic images. It is worth repeating here what has already
been pointed out in other reviews: those who follow the medical books
publishing in Brazil are surprised at the leap of editorial quality
over the past decade. This book is a fine example of today's quality
and carefulness in editions of national medical books, that have reached
the level of foreign books' editions.
The list of the book authors reflects a characteristic of vascular laboratories in the USA. In that country, vascular technologists are responsible for performing Doppler ultrasound examinations. Such technologists, who have a high level of training, perform the exams, choose the proper images, write and sign the reports, which are also signed by a physician, who is technically responsible for the laboratory. In Brazil, on the contrary, it is a physician who almost always performs the examination. Due to these American characteristics, all authors of the book are vascular technologists or nurses, except Prof. Strandness and Dr. Kirk, his right-hand man.
The book is divided into three parts. The first part, written by Prof. Strandness, covers the theoretical aspects, including the history of Doppler ultrasonography, arterial and venous hemodynamics, clinical methods for assessing vascular patients and several chapters on anatomy, physiology, and pathology of different vascular territories. The second part, written by the vascular technologists, harmonically combines theory and practice. This part has been clearly written by and to professionals who perform Doppler ultrasound examinations. Naturally, it contains thousands of useful bits and pieces of information for those who dedicate themselves to non-invasive investigation of vascular diseases. The third part has an extremely practical emphasis, showing how the reports on the different types of examination are made. At the end, Dr. Kirk presents the reader with an excellent appendix on physics applied to Doppler ultrasound devices.
A few criticisms, though restricted, should be addressed to the translation
into Portuguese. The book was translated by a radiologist, who must
have little knowledge of the language used by experts on vascular disorders.
Some examples: "thoracic outlet", translated as drenagem torácica,
should be desfiladeiro torácico; "arterial clamp" was translated
as grampo arterial, but the correct term is pinça or clampe
arterial; "patch" is translated as retalho, although remendo
should have been used. However, this is a minor criticism, considering
the quality of the text.
The book
Duplex Scanning in Vascular Disorders is highly recommended for
beginners and veterans of this new and fascinating specialty called
Vascular Ultrasonography. By acquiring this book, the vascular ultrasonographer
will be, at least, making a posthumous homage to Prof. D. Eugene Strandness,
who was the main responsible for the very existence of his/her specialty.
1. Strandness Jr DE. Ecodoppler Colorido nas Doenças Vasculares. Rio de Janeiro: Guanabara Koogan; 2004.
