Mandolfino T, Canciglia A, D'Alfonso M, Carmignani A
Unit and Specializing School of Vascular Surgery,University of Messina, Messina, Italy.
Int Angiol. 2006 Sep;25(3):256-60.
Recent reports have advocated duplex ultrasound arterial mapping (DUAM) as the sole preoperative imaging modality for planning infrainguinal revascularization. This study reports the outcome of arterial revascularization procedures for chronic limb ischemia based on DUAM.
From January 2002 to December 2004, 253 patients (175 men, 78 women) underwent infrainguinal revascularization based on DUAM. The indications for surgery were severe claudication (11%), rest pain (15%), gangrene (40%), non-healing ulcer (34%). Preoperative evaluation consisted of DUAM alone in 208 cases (82%) or a combination of DUAM and contrast arteriography (CA) in 30 (12%) and intraoperative angiography or direct exploration in 15 (6%). DUAM allowed imaging from the distal aorta to the pedal arteries and the selection of inflow and outflow bypass anastomosis sites. CA was deemed necessary due to technical difficulties or medico-legal reasons.
DUAM procedure time averaged 90+30 min. Proximal anastomosis was located in common femoral arteries in 202 cases, popliteal in 51. Distal anastomosis was to the tibial arteries in 144 cases and pedal arteries in 109. Primary patency was 89% and 67% at 12 and 36 months. Secondary patency was 93% and 82% at 12 and 36 months.
This experience shows that DUAM may be a safe alternative to CA for patients with chronic limb ischemia. Adequate training and experience is necessary to utilize this technique as the sole preoperative imaging modality for planning infrainguinal revascularization.
近期报告主张将双功超声动脉造影（DUAM）作为规划腹股沟下血管重建术的唯一术前成像方式。本研究报告基于DUAM的慢性肢体缺血动脉血管重建手术的结果。
2002年1月至2004年12月，253例患者（175例男性，78例女性）接受了基于DUAM的腹股沟下血管重建术。手术指征为严重跛行（11%）、静息痛（15%）、坏疽（40%）、不愈合溃疡（34%）。术前评估中，208例（82%）仅采用DUAM，30例（12%）采用DUAM与造影动脉造影（CA）相结合的方式，15例（6%）采用术中血管造影或直接探查。DUAM能够对从腹主动脉远端至足部动脉进行成像，并选择流入和流出旁路吻合部位。由于技术困难或法律原因，CA被认为是必要的。
DUAM手术时间平均为90±30分钟。近端吻合位于股总动脉202例，腘动脉51例。远端吻合至胫动脉144例，足部动脉109例。12个月和36个月时的一期通畅率分别为89%和67%。12个月和36个月时的二期通畅率分别为93%和82%。
该经验表明，对于慢性肢体缺血患者，DUAM可能是CA的一种安全替代方法。将该技术作为规划腹股沟下血管重建术的唯一术前成像方式，需要充分的培训和经验。
