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Internal jugular vein anatomy variation Graft surveillance Evaluation of Lower Extremity Bypass Grafts A typical dialysis access graft Ganglion cysts Enlarged lymph node S-Cath World Leader and specialist in Hand-Carried Ultrasound * Figure A shows how the ultrasound probe is placed over the carotid artery. Figure B is a color ultrasound image showing blood flow (the red color in the image) in the carotid artery. Figure C is a waveform image showing the sound of flowing blood in the carotid artery. * The illustration shows a normal artery with normal blood flow (figure A) and an artery containing plaque buildup (figure B). * Fig. 1: Graph demonstrates that volume flow will decrease during a Grade II III stenosis (75% occlusion), as flow velocity is spiking before dropping during a Graft IV stenosis (90% occlusion). (Adapted from Spencer P, Reid, JM, “Quantification of Carotid Stenosis with Continuous-Wave (C-W) Doppler Ultrasound,” Stroke 1979; 10(3) 326-330.) Microvascular Doppler Sonography * The purpose of carotid surgery is to prevent stroke. The risk of stroke increases with increasing degree of carotid stenosis. Numerous studies established the basis for when surgery is needed for carotid occlusive disease. The two widely accepted studies include the NASCET (North American Symptomatic Carotid Endarterectomy Trial), and the ACAS (Asymptomatic Carotid Artery Trial). * The illustration shows the process of carotid endarterectomy. Figure A shows a carotid artery that has plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery is cut and the plaque removed. Figure C shows the artery stitched up and normal blood flow restored. The inset image shows a cross-section of the artery with plaque removed and normal blood flow restored. * Left: Doppler velocity waveforms: (a) triphasic waveform in normal artery; (b) biphasic waveform, with increased velocity, through a mild stenosis; (c) monophasi