使用充血状态下的双功超声扫描改善对临界性髂动脉狭窄血流动力学意义的评估。

Improved assessment of the hemodynamic significance of borderline iliac stenoses with use of hyperemic duplex scanning.

作者信息

Coffi Stephen B, Ubbink Dirk Th, Zwiers Ineke, van Gurp Johan A M, Legemate Dink A

机构信息

Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.

出版信息

J Vasc Surg. 2002 Sep;36(3):575-80. doi: 10.1067/mva.2002.126086.

DOI:10.1067/mva.2002.126086

PMID:12218984

Abstract

OBJECTIVE

To improve the assessment of the hemodynamic significance of borderline iliac stenoses (stenosis with a peak systolic velocity [PSV] ratio between 1.5 and 3.5) by means of hyperemic duplex scanning. The duplex ultrasound parameter-absolute increase in PSV across the stenosis after exercise (Delta PSV(e))-was studied prospectively.

PATIENTS AND METHODS

Fifty-eight legs in 53 consecutive patients with symptomatic arterial obstructive disease with borderline iliac stenosis were studied prospectively. Ultrasound velocity data collected after exercise on a bicycle ergometer at 2 W/kg during 2 minutes were judged against the assessment of the hemodynamic significance by means of intraarterial pressure measurement, before and after the administration of 50 mg papaverine.

RESULTS

On the basis of receiver operating characteristic curves traced for 43 iliac stenoses in 39 patients who finished the exercise, Delta PSV(e) > or = 1.4 m/s had optimal sensitivity of 93% (95% confidence interval [CI],.77-.99), specificity of 87% (95% CI,.60-.98), positive predictive value of 93% (95% CI,.77-.99) and negative predictive value of 87% (95% CI,.60-.98).

CONCLUSIONS

The results of this study show that Delta PSV(e) with a cutoff value of 1.4 m/s in combination with the PSV ratio improves the assessment of the hemodynamic significance of borderline iliac artery stenoses if the patient can accomplish the workload.

摘要

目的

通过充血状态下的双功超声扫描，改善对临界性髂动脉狭窄（收缩期峰值流速[PSV]比值在1.5至3.5之间的狭窄）血流动力学意义的评估。前瞻性地研究了双功超声参数——运动后狭窄处PSV的绝对增加值（ΔPSV(e)）。

患者与方法

对53例连续患有症状性动脉阻塞性疾病且存在临界性髂动脉狭窄的患者的58条腿进行前瞻性研究。在患者以2W/kg的功率在自行车测力计上运动2分钟后收集超声速度数据，并与在给予50mg罂粟碱前后通过动脉内压力测量评估的血流动力学意义进行对比。

结果

根据对39例完成运动的患者的43处髂动脉狭窄绘制的受试者工作特征曲线，ΔPSV(e)≥1.4m/s时，最佳灵敏度为93%（95%置信区间[CI]，0.77 - 0.99），特异性为87%（95%CI，0.60 - 0.98），阳性预测值为93%（95%CI，0.77 - 0.99），阴性预测值为87%（95%CI，0.60 - 0.98）。