Gilbertson J J, Walsh D B, Zwolak R M, Waters M A, Musson A, Magnant J G, Schneider J R, Cronenwett J L
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH 03756.
J Vasc Surg. 1992 Jan;15(1):121-7; discussion 127-9. doi: 10.1067/mva.1992.32985.
Angiography, angioscopy, and duplex scanning have each been advocated for intraoperative assessment of in situ saphenous vein grafts. We compared these three modalities during operation in a prospective, blinded study during the construction of 20 femoral-infragenicular in situ saphenous vein grafts. Each modality was used and interpreted by a surgeon blinded to the results of the other studies. Abnormalities requiring intervention were defined as (1) patent vein side branches, (2) residual valve cusps, and (3) anastomotic stenoses greater than 30%. Criteria, specific to the modality, corresponding to each category were prospectively defined. Fourteen residual valve cusps, 49 patent vein branches, and 6 anastomotic stenoses were suggested by at least one modality. Nine residual valve cusps, 32 patent vein branches, and no anastomotic stenoses were actually found (and corrected) by direct inspection. Sensitivity of detecting patent side branches for angiography, duplex scanning, and angioscopy was 44%, 12%, and 66%, respectively. Both angiography and angioscopy were significantly more sensitive than duplex scanning for detection of unligated side branches (p less than 0.01). Sensitivity of detecting residual valve cusps was 22% (angiography), 11% (duplex scanning), and 100% (angioscopy). Angioscopy was significantly more sensitive than either duplex scanning or angiography in detection of residual valve cusps (p less than 0.01). Since no anastomotic stenoses were confirmed, the false-positive rates for stenosis detection were 20% for angiography, 10% for duplex scanning, and 0% for angioscopy. Time requirement was 17 to 20 minutes and did not differ among the three modalities. No stenosis or arteriovenous fistula has been detected in any graft by postoperative duplex surveillance (mean, 10-month follow-up).(ABSTRACT TRUNCATED AT 250 WORDS)
血管造影、血管内镜检查和双功扫描均被推荐用于原位大隐静脉移植血管的术中评估。在一项前瞻性、盲法研究中，我们在构建20条股-膝下原位大隐静脉移植血管的手术过程中比较了这三种方式。每种方式均由对其他研究结果不知情的外科医生使用和解读。需要干预的异常情况定义为：（1）通畅的静脉侧支；（2）残留的瓣膜叶；（3）吻合口狭窄大于30%。针对每种方式，对应每个类别的特定标准是预先确定的。至少一种方式提示有14个残留瓣膜叶、49个通畅的静脉分支和6处吻合口狭窄。通过直接检查实际发现（并纠正）了9个残留瓣膜叶、32个通畅的静脉分支，且未发现吻合口狭窄。血管造影、双功扫描和血管内镜检查检测通畅侧支的敏感度分别为44%、12%和66%。在检测未结扎侧支方面，血管造影和血管内镜检查均比双功扫描敏感得多（p<0.01）。检测残留瓣膜叶的敏感度分别为：血管造影22%、双功扫描11%、血管内镜检查100%。在检测残留瓣膜叶方面，血管内镜检查比双功扫描或血管造影敏感得多（p<0.01）。由于未确认有吻合口狭窄，血管造影检测狭窄的假阳性率为20%，双功扫描为10%，血管内镜检查为0%。三种方式的时间需求为17至20分钟，且无差异。术后双功超声监测（平均随访10个月）未在任何移植血管中检测到狭窄或动静脉瘘。（摘要截短至250字）
