FIG. 5.

Serial B-Mode, ARFI peak displacement (PD) and hybrid ARFI/B-Mode images of the femoral arteriotomy in a 52 year-old female volunteer at 7 (left column), 8 (middle column) and 14 (right column) min following sheath removal. Hemostasis was achieved by manual compression alone. B-Mode images (top row, panels (a), (b) and (c)) offer no indication of arteriotomy (circled) or bleeding. The raw ARFI PD image (middle row) 7 minutes post sheath removal (panel (d)) shows displacement in the position of the arteriotomy (circled) comparable to that of the adjacent arterial wall tissue, with uniformly low displacement in the soft tissue above the artery. Pressure was reduced after 7 min. The raw ARFI PD image 8 min following sheath removal (panel (e)) shows larger displacement in the position of the arteriotomy (circled) as well as large displacements in the tissue above the artery (arrows), suggesting an increase in the volume of pooled extravasated blood. Fourteen min following sheath removal (panel (f)), large displacements are still seen at the arteriotomy (circled) and in the soft tissue (arrows), suggesting continued bleeding. The hybrid ARFI/B-Mode images (third row, panels (g), (h) and (i)) more clearly indicate the increasing estimated extravasated blood area. Large displacements at the arteriotomy (circled, panels (h) and (i) are preserved. The scatter plot of estimated extravasated blood area versus time (panel (j)) shows an initial drop in area at 5 min followed by increasing area from 8-15 min, which is suggestive of re-bleeding. Notably, this patient developed a hematoma.