A comprehensive review of vascular ultrasound for intensivists

Ultrasound has an increasingly important role in evaluation of the vascular system. Ultrasound is especially useful for intensive care patients because of the frequency of vascular complications developing in the ICU setting, as well as the ability of ultrasound to be performed at the patient's bedside. Ultrasound is the method of choice for evaluation of deep vein thromboembolic disease of the lower extremity in all patients; it demonstrates excellent sensitivity and specificity for this condition. It should also be the initial method of evaluation of upper extremity deep vein thrombosis. However, ultrasound may be limited in this assessment due to lack of reliably demonstrating the central subclavian and innominate veins, and therefore may be inadequate for evaluation of malfunctioning central venous catheters. Ultrasound can reliably identify and potentially be used to treat arterial complications of arterial catheterization, such as pseudoaneurysms. Similarly, ultrasound is accurate in the diagnosis of the presence of abdominal aortic aneurysm, and ultrasound can be used to assess carotid and lower extremity arteries noninvasively. Finally, ultrasound is useful for evaluation of hemodialysis fistulas and vascular complications of transplants.