Mestre X Martì, Castellote M A Cairols, Coll R Vila, Villegas A Romera
Vascular Surgery and Angiology Department, University Hospital of Bellvitge, Barcelona, Spain.
Int Angiol. 2009 Jun;28(3):209-14.
Arteriography is the gold-standard in decision making in patients with critical lower-limb ischemia. Such method is not bereft of side effects and only gives morphologic information about lesions. Duplex allows to evaluate hemodynamically the arteriosclerotic lesions of ischemic lower limbs non-invasivelly and with the same reliability, in some studies, as angiography. Aim of this study was to determine the value and safety of arterial ultrasonic mapping in decision making for treatment of critical lower-limb ischemia.
This was a prospective and comparative study in patients with critical lower-limb ischemia recruited from March 2005 to June 2006. Ultrasonic arterial mapping was performed in 130 patients. Arteriography was performed only in those patients with elevated risk of major amputation or if ultrasound was not feasible (44 patients). Patients were randomized into two groups according to decision making criteria: 1) group A based on mapping alone; 2) group B based on arteriography. There was no statistical difference between risk factors in the two groups (P>0.05). Cumulative patency was recorded and compared at one and three months (Log Rank) as well as degree of concordance of decision making using mapping and arteriography in the group with both tests (B); and degree of concordance of the two tests with decision making based on intraoperative findings.
The degree of concordance between mapping and arteriography was 84.1% (P<0.0001), and the degree of concordance between mapping and arteriography with respect to final decision according to intraoperative findings was 93.1% and 97.7%, respectively (P<0.0001). There were no statistically significative differences in patency rates at one and three months between the two groups (P>0.05).
Ultrasonic arterial mapping is sufficient and comparable to arteriography for purposes of decision making in patients with critical lower-limb ischemia.
动脉造影是下肢严重缺血患者决策制定的金标准。该方法并非没有副作用，且仅提供病变的形态学信息。双功超声检查能够以非侵入性方式对缺血性下肢的动脉硬化病变进行血流动力学评估，并且在一些研究中，其可靠性与血管造影相同。本研究的目的是确定动脉超声造影在下肢严重缺血治疗决策中的价值和安全性。
这是一项对2005年3月至2006年6月招募的下肢严重缺血患者进行的前瞻性比较研究。对130例患者进行了超声动脉造影。仅对那些有大截肢高风险或超声检查不可行的患者进行了动脉造影（44例患者）。根据决策标准将患者随机分为两组：1）仅基于造影的A组；2）基于动脉造影的B组。两组危险因素之间无统计学差异（P>0.05）。记录并比较1个月和3个月时的累积通畅率（对数秩检验），以及在同时进行两种检查的组（B组）中使用造影和动脉造影进行决策的一致性程度；以及两种检查与基于术中发现的决策的一致性程度。
造影与动脉造影之间的一致性程度为84.1%（P<0.0001），根据术中发现，造影与动脉造影在最终决策方面的一致性程度分别为93.1%和97.7%（P<0.0001）。两组在1个月和3个月时的通畅率无统计学显著差异（P>0.05）。
对于下肢严重缺血患者的决策制定而言，超声动脉造影足以与动脉造影相媲美。
