title: Detection and localization of peripheral vascular bleeding using Doppler ultrasound.
abstract: BACKGROUND
  Hemorrhage from wounds in the extremities is the leading cause of preventable death on the battlefield. To successfully treat these injuries, the exact source of bleeding must be localized.
  
  
  OBJECTIVE
  The purpose of this study was to determine the feasibility of using Doppler ultrasound to precisely detect and localize peripheral vascular bleeding.
  
  
  METHODS
  Injuries were produced in common femoral arteries (diameter of ∼5 mm) of 28 pigs in vivo. Single puncture injuries were produced using 6 French (F) (n = 10), 9 F (n = 22), and 12 F (n = 12) catheters. In addition, multiple punctures were made (using 6 F and 9 F catheters) in eight common femoral arteries to simulate bleeding from multiple injuries. Finally, laceration injuries were produced using a scalpel in 10 femoral vessels.
  
  
  RESULTS
  In color Doppler images, bleeding was observed as a turbulent jet flow originating from the injury site in the vessel. This jet flow had checkered red-blue color pattern at the bleeding site, as opposed to a uniform color pattern in an intact artery. Peak systolic velocity at the injury site, measured using pulsed Doppler, was elevated to up to 152.0 ± 81.6 cm/s, as compared to 78.8 ± 17.5 cm/s in normal arteries. Further, end diastolic velocity increased from 6.1 ± 4.9 cm/s before the injury to up to 59.1 ± 33.1 cm/s after the injury. Resistance index was significantly lower (0.6 for 9 F and 12 F punctures, and 0.8 for 6 F punctures) at the bleeding site in injured arteries as compared to the resistance index of intact arteries (of 0.9).
  
  
  CONCLUSIONS
  Our results showed a characteristic change in the systolic and diastolic velocities, as well as resistance indices at the injury site in peripheral arteries. These findings may serve as groundwork for development of automated bleeding detection and localization methods, and facilitate various hemorrhage control treatments.
authors.affiliation: Department of Bioengineering, University of Washington, Seattle, Washington 98195, USA.
authors.forename: Wenbo
authors.initials: W
authors.lastname: Luo
authors.forename: Hamid
authors.initials: H
authors.lastname: Hosseini
authors.forename: Vesna
authors.initials: V
authors.lastname: Zderic
authors.forename: Frederick
authors.initials: F
authors.lastname: Mann
authors.forename: Grant
authors.initials: G
authors.lastname: O'Keefe
authors.forename: Shahram
authors.initials: S
authors.lastname: Vaezy
mesh_terms: D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005263:Femoral Artery / Q000293:injuries*; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D009104:Multiple Trauma / Q000000981:diagnostic imaging; D013552:Swine; D018608:Ultrasonography, Doppler / Q000379:methods; D014655:Vascular Resistance / Q000502:physiology; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*