Case Studies

Cardiac Cases

Cardiac Cases

What to do when the flow doesn’t improve as expected?

This clinical case illustrates the swift identification of graft issues during arterial revascularization surgery through TTFM and HFUS.

Vascular Cases

Vascular Cases

HFUS detects major defects after CEA with no findings on angio

This case illustrates how High-Frequency Ultrasound (HFUS) enables more correct detection of higher-grade defects than angiography after CEA. In an 83-year-old male with symptomatic 70% common carotid artery stenosis and multiple comorbidities, HFUS revealed a grade 3 defect, notably absent on angiography due to suboptimal quality.

Vascular Cases

Vascular Cases

Lower limb bypass: Convincing results using TTFM as completion control

Dr. Michael Yacob from Ontario, Canada, underscores the significance of TTFM in assessing graft patency during lower limb bypass surgery.

Vascular Cases

Vascular Cases

Vein dissection in a forearm AV fistula

This case shows how intraoperative TTFM and HFUS revealed a dissection in the outflow vein during radio-cephalic side-to-end fistula creation, resulting in immediate revision.

Cardiac Cases

Cardiac Cases

A rare case of Subclavian steal, caused by an arteriovenous fistula

In this CABG case featuring a patient with end-stage renal disease, the LITA graft demonstrated retrograde blood flow, which suggested...

Vascular Cases

Vascular Cases

Detecting defects after Carotid Endarterectomy: A comparison between HFUS vs. Angiography

This case illustrates how ultrasound imaging enables more correct detection of higher-grade defects than angiography after CEA. The case is provided by the authors of the CIDAC Study.

Vascular Cases

Vascular Cases

Securing a Fem-Pop Bypass by using TTFM and HFUS

Performing quality control during peripheral bypass surgery is important to secure optimal patency of the graft to avoid re-operation or secondary intervention. In this case, Transit Time Flow Measurement (TTFM), High-Frequency Ultrasound (HFUS), and angio verified distal flow before closing the wounds.

Cardiac Cases

Cardiac Cases

Novel use of HFUS to identify myocardial bridge

Intriguing case featured in the paper: "Epicardial Ultrasound in a Case of Myocardial Bridge and Apical Hypertrophic Cardiomyopathy" by Lindsey Whalen, Stephen Davies, Karen Singh, and Gorav Ailawadi.

Cardiac Cases

Cardiac Cases

TTFM & HFUS confirms hematoma in LIMA

Knowing whether an underperforming conduit should be rejected or not is very valuable information. This case from the REQUEST study describes how the combined use of Transit Time Flow Measurement (TTFM) and High-Frequency Ultrasound (HFUS) allowed the surgeon to make informed decisions before proceeding.

Transplant Cases

Transplant Cases

Liver Tx: Guiding inflow modulation with TTFM

This case demonstrates how Transit Time Flow Measurement (TTFM) can be used during liver transplant surgery as a guide when modulating the portal venous flow (PVF) to avoid hepatofugal flow.

Cardiac Cases

Cardiac Cases

TTFM & HFUS verifies graft patency in graft with competitive flow

Graft patency verification can be difficult in cases with competitive flow. This case from the REQUEST study describes how the combined use of Transit Time Flow Measurement (TTFM) and High-Frequency Ultrasound (HFUS) allowed the surgeon to make informed decisions about how to proceed.

Transplant Cases

Transplant Cases

Liver Tx: Thrombus in Hepatic Artery detected with HFUS

This case demonstrates how High-Frequency Ultrasound (HFUS) can detect thrombus in the hepatic artery even when Transit Time Flow Measurement (TTFM) did not reveal any flow related issues.

Transplant Cases

Transplant Cases

Liver Tx: Compromised anastomosis detected with TTFM

This case demonstrates how Transit Time Flow Measurement (TTFM) can be used during liver transplant surgery to detect technical errors.

Cardiac Cases

Cardiac Cases

Dissected LIMA discovered by use of TTFM & HFUS

This case from the REQUEST study describes how the combined use of Transit Time Flow Measurement (TTFM) and High-Frequency Ultrasound (HFUS) revealed a dissected LIMA. These insights helped the surgeon identify the issue and address it appropriately.

Cardiac Cases

Cardiac Cases

Flow complication avoided by use of TTFM & HFUS

This case from the REQUEST study describes how the combined use of Transit Time Flow Measurement (TTFM) and High frequency ultrasound (HFUS) revealed a compromised graft. These insights helped the surgeon identify the issue and address it appropriately.

Transplant Cases

Transplant Cases

Meso-Rex shunt: Thrombus detected with TTFM and HFUS

This case demonstrates how Transit Time Flow Measurement (TTFM) and High-Frequency Ultrasound (HFUS) were instrumental in avoiding a catastrophic incident. A thrombus in the saphenous vein graft (SVG) was detected during surgery.

Cardiac Cases

Cardiac Cases

Purse string effect revealed by TTFM and HFUS

This case from the REQUEST study describes how the combined use of Transit Time Flow Measurement (TTFM) and High-Frequency Ultrasound (HFUS) revealed a compromised anastomosis, enabling the surgeon to handle the situation appropriately.

Vascular Cases

Vascular Cases

Kinked Internal Carotid Artery during CEA: Revision avoided due to TTFM

This case shows the benefit of using Transit Time Flow Measurement (TTFM) in addition to High-Frequency Ultrasound (HFUS) after CEA when dealing with a kinked ICA.

Cardiac Cases

Cardiac Cases

Identifying aortic dissection with HFUS

See how High-frequency Ultrasound Imaging (HFUS) can be used to identify or locate aortic dissections. Early discovery and precise location of this highly critical incident can be very significant to the outcome of the procedure.

Vascular Cases

Vascular Cases

Unique findings with TTFM and HFUS during CEA

This case shows that the expectation of a huge increase in flow is not always met in every case. However, Transit Time Flow Measurement (TTFM) showing changes in the flow curve and High-Frequency Ultrasound (HFUS) can reveal otherwise undetected issues.

Cardiac Cases

Cardiac Cases

Minimizing aortic manipulation using HFUS

This case from the REQUEST study illustrates how High-Frequency Ultrasound Imaging (HFUS) can be used to identify soft, non-palpable plaque in the aorta, thus avoiding unnecessary manipulation of the affected areas.

Vascular Cases

Vascular Cases

Peripheral bypass reoperation: Detection of thrombus and side branches in graft

A patient was readmitted on post-OP day 8 due to pain in the leg after a fem-pop in-situ bypass. This case shows how Transit Time Flow Measurement (TTFM) and High-Frequency Ultrasound was used during the reoperation.

Cardiac Cases

Cardiac Cases

Undetected plaque in aorta led to surgical change

HFUS identifies previously undetected plaque in the aorta.

Vascular Cases

Vascular Cases

AV Access reoperation due to low flow

This case illustrates a low-flow situation of a Cimino fistula on the left forearm with a juxta-anastomotic stenosis. Transit Time Flow Measurement (TTFM) and High-frequency Ultrasound Imaging (HFUS) served as completion control.

Vascular Cases

Vascular Cases

Fem-pop bypass: Quality control with TTFM, HFUS and PW Doppler

Quality assessment of a bypass procedure using all 3 technologies provided by the MiraQ system.

Cardiac Cases

Cardiac Cases

High-frequency ultrasound imaging of LAD embedded 6 mm deep

This case from the REQUEST study illustrates how High-Frequency Ultrasound Imaging can be used during surgery to detect intramural vessels, to avoid complications, and improve graft patency.

Vascular Cases

Vascular Cases

Thrombus detected with HFUS after CEA

Illustration of how ultrasound imaging enables more correct detection of higher-grade defects than angiography after CEA.

Cardiac Cases

Cardiac Cases

Dissected LIMA detected by use of HFUS

This case from the REQUEST study illustrates how High-Frequency Ultrasound Imaging can be used during surgery to detect unexpected issues with the conduit to avoid complications and improve graft patency.

Cardiac Cases

Cardiac Cases

Lessons learned – trust your flow numbers!

In this clinical case, an experienced surgeon initially overlooked critical flow measurement findings during CABG, leading to a decision not to revise a graft despite indications of potential complications.

Cardiac Cases

Cardiac Cases

Insights from the randomized CTSN VEST trial show low flow and high PI associated with worse outcomes

In this recently published secondary analysis from the within-patient randomized CTSN VEST trial the authors present several interesting findings on the association between intimal hyperplasia (IH) area and clinical measures of saphenous vein graft (SVG) disease.