Shrikhande Gautam V, Graham Ashley R, Aparajita Ritu, Gallagher Kathy A, Morrissey Nicholas J, McKinsey James F, Dayal Rajeev
Division of Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Ann Vasc Surg. 2011 May;25(4):454-60. doi: 10.1016/j.avsg.2010.12.017.
Studies examining duplex surveillance of lower extremity bypass grafts have defined a role for guiding graft re-intervention. The goal of this study is to determine the utility of duplex scanning to detect angiographic restenosis after endovascular therapy in patients with infrainguinal arterial disease.
A prospective registry including all patients treated for lower extremity atherosclerotic disease between February 2004 and September 2008 was established. Patients were followed up with duplex ultrasound at 1, 3, 6, 12 months, and then annually. Patients receiving repeat angiograms were identified and angiogram and duplex data were abstracted. Velocity ratios (Vr) were calculated for each lesion by dividing the peak velocity within the lesion by the peak velocity proximal to the lesion. Logarithmic regression and receiver operator characteristic (ROC) curve analyses were used.
Repeat angiograms were performed on 345 lesions in 143 patients, and 254 lesions in 103 patients had a corresponding duplex ultrasound. Indications for the initial intervention were claudication (n = 62, 43.4%), rest pain (n = 23, 16.1%), and tissue loss (n = 58, 40.5%). A total of 178 superficial femoral artery (SFA) lesions, 59 popliteal lesions, and 17 tibial lesions were identified by surveillance duplex in 103 patients. In all, 70.5% of the intervened vessels that were studied were nonstented and the remaining 29.5% were stented. A total of 65% of the patients had diabetes. On determining correlations for peak systolic velocity (PSV) as measured by duplex ultrasound with degree of angiographic stenosis, strong correlation coefficients for SFA disease (R² = 0.84) and popliteal disease (R² = 0.88) were found. However, poor correlation was found in patients with tibial disease. When analyzing the lesions on the basis of Vr < 2.0, 11 of 86 (12.8%) had >70% angiographic stenosis. In lesions with ratios from 2 to 2.5, 12 of 13 (92.3%) had >70% angiographic stenosis and in lesions with ratios >2.5, 69 of 75 (92.0%) had >70% angiographic stenosis. ROC curve analysis showed that to detect ≥ 70% stenosis in the SFA, a PSV ≥ 204 cm/sec had a sensitivity of 97.6% and specificity of 94.7%. To detect ≥ 70% stenosis in the overall femoropopliteal region, a PSV ≥ 223 cm/sec had a sensitivity of 94.1% and specificity of 95.2%.
Duplex ultrasound surveillance correlates to the degree of angiographic stenosis on the basis of PSV in the SFA and popliteal region. Correlation in the tibial vessels is poor. Vr > 2.0 appear to correlate to angiographic stenosis of > 70%. ROC analysis shows that PSV can have sufficiently high sensitivity and specificity to predict angiographic stenosis in the femoropopliteal region.
关于下肢旁路移植血管双功超声监测的研究已明确其在指导移植血管再次干预方面的作用。本研究的目的是确定双功扫描在检测股腘动脉疾病患者血管内治疗后血管造影再狭窄中的效用。
建立了一个前瞻性登记系统，纳入2004年2月至2008年9月期间所有接受下肢动脉粥样硬化疾病治疗的患者。患者在1、3、6、12个月时接受双功超声随访，之后每年随访一次。确定接受重复血管造影的患者，并提取血管造影和双功超声数据。通过将病变内的峰值速度除以病变近端的峰值速度来计算每个病变的速度比（Vr）。采用对数回归和受试者操作特征（ROC）曲线分析。
对143例患者的345个病变进行了重复血管造影，103例患者的254个病变有相应的双功超声检查。初始干预的指征为间歇性跛行（n = 62，43.4%）、静息痛（n = 23，16.1%）和组织缺损（n = 58，40.5%）。在103例患者中，通过监测双功超声共识别出178个股浅动脉（SFA）病变、59个腘动脉病变和17个胫动脉病变。在接受研究的干预血管中，70.5%未置入支架，其余29.5%置入了支架。共有65%的患者患有糖尿病。在确定双功超声测量的收缩期峰值速度（PSV）与血管造影狭窄程度的相关性时，发现SFA疾病（R² = 0.84）和腘动脉疾病（R² = 0.88）的相关系数较强。然而，在胫动脉疾病患者中相关性较差。根据Vr < 2.0分析病变时，86个病变中有11个（12.8%）血管造影狭窄>70%。在Vr为2至2.5的病变中，13个病变中有12个（92.3%）血管造影狭窄>70%，在Vr > 2.5的病变中，75个病变中有69个（92.0%）血管造影狭窄>70%。ROC曲线分析显示，要检测SFA中≥70%的狭窄，PSV≥204 cm/秒时，敏感性为97.6%，特异性为94.7%。要检测整个股腘区域中≥70%的狭窄，PSV≥223 cm/秒时，敏感性为94.1%，特异性为95.2%。
双功超声监测与基于SFA和腘动脉区域PSV的血管造影狭窄程度相关。胫动脉血管的相关性较差。Vr > 2.0似乎与>70%的血管造影狭窄相关。ROC分析表明，PSV在预测股腘区域血管造影狭窄方面具有足够高的敏感性和特异性。
