Introduction: Ultrasound is central to vascular imaging because of its accessibility, safety, and real-time capabilities, yet conventional duplex interpretation remains limited by operator dependence and qualitative assessment. Ultrasound-based radiomics and artificial intelligence (AI) offer opportunities to extract quantitative imaging biomarkers and improve reproducibility in vascular disease evaluation. Methods: A narrative review was conducted using PubMed and Scopus, including studies published between 2018 and 2025 that evaluated ultrasound-based radiomics or AI in vascular disease. Emphasis was placed on duplex ultrasound applications relevant to arterial, venous, and aneurysmal pathology, while computed tomography- or magnetic resonance imaging-only radiomics studies were excluded. Results: Evidence indicates that ultrasound-based radiomics and AI enhance plaque characterization, automate segmentation, and support risk stratification in carotid artery disease, peripheral arterial disease, venous thromboembolism, and abdominal aortic aneurysms. These approaches reduce interobserver variability and enable standardized longitudinal assessment, although most studies remain retrospective. Discussion: Clinical translation is constrained by acquisition variability, limited external validation, and challenges integrating AI tools into established vascular laboratory workflows. Current evidence supports AI primarily as a decision-support adjunct rather than a replacement for expert interpretation. Conclusion: Ultrasound-based radiomics and AI are evolving adjuncts to vascular ultrasound. With standardized acquisition and validation, these techniques may enhance reproducibility and care.
Stationary or standing arterial waves are rare and poorly understood vascular imaging findings, most commonly visualized on conventional angiography. They have been documented on computed tomography angiography and magnetic resonance angiography, but, to date, documentation of this phenomenon using ultrasound has been exceedingly rare. We present 2 cases in which sinusoidal, wave-like undulations along the arterial wall were initially identified on duplex ultrasound, with corresponding findings later confirmed on angiographic imaging. To our knowledge, these cases represent some of the few reported instances where ultrasound served as the primary detection modality. These observations challenge the notion that stationary arterial waves are exclusive to angiographic techniques and support a potential pathophysiological basis for their occurrence.
Chronic limb-threatening ischemia requires timely physiologic assessment of limb perfusion, yet access to comprehensive vascular ultrasound may be limited in many clinical settings. In this context, we propose a distal-first spectral Doppler approach with selective proximal extension as a conceptual framework for focused physiologic assessment when full arterial duplex mapping by experienced examiners is not readily available. The aim is to support early screening and triage within the diagnostic pathway, not to replace standard comprehensive (proximal-to-distal) mapping. The approach is based on the principle that preserved multiphasic distal arterial waveforms are unlikely in the presence of hemodynamically significant proximal inflow impairment. The protocol begins with distal waveform assessment and extends proximally only when findings suggest hemodynamic compromise. The article outlines the physiologic rationale and provides a stepwise description of the protocol, including acquisition, interpretation, and reporting elements.
Introduction: Superficial epigastric vein (SEV) flow reversal has been described as an indirect duplex ultrasound marker of iliocaval venous obstruction (VO), but data describing its clinical characteristics and diagnostic implications in routine vascular laboratory practice are limited. This study evaluated the demographic, anatomic, and imaging features of venous duplex patients demonstrating SEV flow reversal during evaluation for deep vein thrombosis (DVT). Methods: A retrospective review of lower extremity venous DVT duplex examinations was conducted between March 2021 and November 2025. Patients demonstrating abnormal SEV flow reversal were identified using the vascular laboratory reporting system and electronic medical records. Demographics, VO risk factors, DVT chronicity and distribution, laterality, and the presence of abdominal or pelvic pathology were recorded. Interventional radiographic (IR) imaging performed within 90 days of the duplex examination served as confirmatory evidence of VO. Results: Sixty-one patients (105 extremities) demonstrated SEV flow reversal. The cohort was predominantly female (74%, P < .001), with a mean age of 65 years (range, 16-89). Prior DVT was more common in the left lower extremity ( P = .005). Current DVT was present in 67 extremities, with chronic thrombus significantly more prevalent than acute thrombus ( P < .001). Superficial epigastric vein flow reversal occurred more frequently in the left lower extremity ( P = .003) and was most associated with left iliac or iliocaval DVT. All 16 extremities with IR correlation demonstrated iliocaval VO. Conclusion: Superficial epigastric vein flow reversal is a markedly abnormal duplex finding that demonstrates a strong association with iliocaval VO. In patients undergoing evaluation for DVT, routine assessment of SEV flow direction may offer a rapid, reproducible adjunct to standard venous duplex protocols and help improve detection of clinically significant iliocaval disease.
