Elmahdy Mahmoud Farouk, Ghareeb Mahdy Soliman, Baligh Ewiss Essam, Said Kareem, Kassem H H, Ammar Waleed
Cardiovascular Department, Cairo University, Cairo 11451, Egypt.
Cardiovasc Revasc Med. 2010 Oct-Dec;11(4):223-6. doi: 10.1016/j.carrev.2009.09.001.
Management of acute limb ischemia (ALI) is largely based on the etiology of arterial occlusion (embolic vs. thrombotic). To our knowledge, the ability of duplex scanning to differentiate embolic from thrombotic occlusion has not been previously reported.
To determine the ability of duplex scanning to differentiate embolic from thrombotic acute arterial occlusion.
We prospectively recruited 97 patients (50.3 ± 19.7 years; 55% males) with 107 nontraumatic ALI in native arteries. All patients underwent surgical revascularization. Preoperative duplex scan detected arterial occlusion in the following arteries: iliac (11), femoral (38), popliteal (38), infrapopliteal (3), subclavian (3), axillary (1), brachial (9), and forearm arteries (4). We measured the arterial diameters at the site of occlusion (d(occl)) and at the corresponding contralateral healthy side (d(CONTRA)). The difference (Δ) between the two diameters was calculated as d(OCCL)-d(CONTRA). Duplex scan was also used to assess the state of the arterial wall whether healthy or atherosclerotic and the presence of calcification or collaterals. According to surgical findings, limbs were classified into embolic (E group=55 limbs) and thrombotic (T group=52 limbs) groups.
Both groups were comparable regarding age, diabetes, hypertension, smoking, atrial fibrillation, and time of presentation. The status of arterial wall at the site of occlusion and presence of calcification or collaterals were all similar in both groups. Δ in the E group was 0.95 ± 0.92 mm vs. -0.13 ± 1.02 mm in the T group (P<.001). A value of ≥ 0.5 mm for Δ had 85% sensitivity and 76% specificity for the diagnosis of embolic occlusion (CI 0.72-0.90, P<.001), whereas a value of less than -0.5 mm for Δ had 85% sensitivity and 76% specificity for thrombotic occlusion (CI 0.72-0.90, P<.001).
In acute arterial occlusion, ≥ 0.5 mm dilatation or diminution in the occluded artery diameter is a useful duplex sign for diagnosing embolic or thrombotic occlusion, respectively.
急性肢体缺血（ALI）的治疗很大程度上基于动脉闭塞的病因（栓塞性与血栓性）。据我们所知，之前尚未报道过双功超声扫描区分栓塞性闭塞与血栓性闭塞的能力。
确定双功超声扫描区分栓塞性与血栓性急性动脉闭塞的能力。
我们前瞻性招募了97例（年龄50.3±19.7岁；55%为男性）患有107例非创伤性天然动脉ALI的患者。所有患者均接受了手术血运重建。术前双功超声扫描检测到以下动脉发生动脉闭塞：髂动脉（11例）、股动脉（38例）、腘动脉（38例）、腘以下动脉（3例）、锁骨下动脉（3例）、腋动脉（1例）、肱动脉（9例）和前臂动脉（4例）。我们测量了闭塞部位的动脉直径（d(occl)）以及相应对侧健康部位的动脉直径（d(CONTRA)）。计算这两个直径的差值（Δ），即d(OCCL)-d(CONTRA)。双功超声扫描还用于评估动脉壁的状态（健康或动脉粥样硬化）以及钙化或侧支循环的存在情况。根据手术结果，将肢体分为栓塞性（E组=55条肢体）和血栓性（T组=52条肢体）两组。
两组在年龄、糖尿病、高血压、吸烟、心房颤动和就诊时间方面具有可比性。两组在闭塞部位的动脉壁状态以及钙化或侧支循环的存在情况均相似。E组的Δ为0.95±0.92mm，而T组为-0.13±1.02mm（P<0.001）。Δ≥0.5mm对栓塞性闭塞诊断的敏感性为85%，特异性为76%（CI 0.72 - 0.90，P<0.001），而Δ小于-0.5mm对血栓性闭塞诊断的敏感性为85%，特异性为76%（CI 0.72 - 0.90，P<0.001）。
在急性动脉闭塞中，闭塞动脉直径≥0.5mm的扩张或缩小分别是诊断栓塞性或血栓性闭塞的有用双功超声征象。
