Hofmann W J, Walter J, Ugurluoglu A, Czerny M, Forstner R, Magometschnigg H
Division of Vascular Surgery, St John's Hospital, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria.
J Vasc Surg. 2004 Jan;39(1):169-75. doi: 10.1016/s0741-5214(03)01044-9.
The aim of this prospective study conducted at a tertiary referral center was to evaluate the efficacy of high-frequency duplex scanning in the preoperative evaluation of potential pedal target vessels. Material and methods The study population consisted of thirty-three consecutive diabetics suffering critical limb ischemia, with indications of infra-popliteal occlusive disease. Duplex ultrasound was performed by an angiologist unaware of any prior imaging procedures. The pedal vessels were divided into four segments. The inner diameter-, the grade of calcification (on a scale from 1-to-3), the maximal systolic velocity, and the resistance index ([V.max syst-V min syst]/V max syst), were assessed by using a 13-MHz probe, and the pedal target vessel best suited for surgery was identified. Results of duplex scanning were compared to (1) the results of selective digital subtraction angiography (DSA) and contrast-enhanced magnetic resonance angiography (CE-MRA) studies interpreted by two radiologists, (2) the site of distal anastomosis predicted by a vascular surgeon according to DSA and CE-MRA studies, (3) the definitive site of distal anastomosis, and (4) early postoperative results (patency at three months).
Duplex scanning depicted significantly more pedal vascular segments than selective DSA- (P =.004, McNemar test). Agreement in predicting the site of distal anastomosis expressed as kappa value as follows: duplex versus DSA/CE-MRA, kappa 0.71;-DSA/CE-MRA versus definitive anastomosis, kappa 0.67; -and duplex versus definitive anastomosis kappa 0.82. Two patients were excluded from surgery as all three imaging modalities failed to demonstrate a pedal target vessel. Two patients had exploratory dissection of a pedal vessel (according to CE-MRA findings) that turned out to be occluded (as predicted by duplex scanning). In one patient the operation had to be terminated due to lack of autologous bypass material. In 31 patients who underwent pedal artery bypass, the resistance index could not be correlated to the run-off as assessed by intra-operative angiography.
High-frequency duplex focusing on the vacular-morphology is a worthwhile diagnostic tool to evaluate-potential pedal target vessels and extremely helpful when contrast-related methods (selective DSA, CE-MRA) do not sufficiently depict the pedal vasculature.
在一家三级转诊中心进行的这项前瞻性研究的目的是评估高频双功扫描在术前评估潜在足部目标血管中的有效性。材料与方法研究人群包括33例连续性患有严重肢体缺血且有腘下闭塞性疾病指征的糖尿病患者。双功超声由一位不了解任何先前成像检查的血管造影专家进行。足部血管被分为四个节段。使用13兆赫探头评估内径、钙化程度（1至3级）、最大收缩期速度和阻力指数（[最大收缩期速度 - 最小收缩期速度]/最大收缩期速度），并确定最适合手术的足部目标血管。将双功扫描结果与以下各项进行比较：（1）由两位放射科医生解读的选择性数字减影血管造影（DSA）和对比增强磁共振血管造影（CE - MRA）研究结果；（2）血管外科医生根据DSA和CE - MRA研究预测的远端吻合部位；（3）远端吻合的确切部位；（4）术后早期结果（三个月时的通畅情况）。
双功扫描显示的足部血管节段明显多于选择性DSA（P = 0.004，McNemar检验）。以kappa值表示的预测远端吻合部位的一致性如下：双功扫描与DSA/CE - MRA，kappa 0.71；DSA/CE - MRA与确切吻合部位，kappa 0.67；双功扫描与确切吻合部位，kappa 0.82。两名患者因所有三种成像方式均未能显示足部目标血管而被排除在手术之外。两名患者对一条足部血管进行了探查性解剖（根据CE - MRA结果），结果发现该血管闭塞（如双功扫描所预测）。一名患者因缺乏自体旁路材料而不得不终止手术。在31例行足部动脉旁路手术的患者中，阻力指数与术中血管造影评估的血流情况无相关性。
聚焦血管形态的高频双功扫描是评估潜在足部目标血管的一种有价值的诊断工具，当与造影相关的方法（选择性DSA、CE - MRA）不能充分显示足部血管系统时极其有用。
