Schmitt D D, Seabrook G R, Bandyk D F, Cato R F, Edwards J W, Karp D L, Block J L, Towne J B
Department of Surgery, Medical College of Wisconsin, Milwaukee.
Ann Vasc Surg. 1990 May;4(3):270-5. doi: 10.1007/BF02009456.
Intraoperative velocity waveform analysis following in situ saphenous vein bypass grafting can identify abnormal hemodynamic conditions that correlate with the presence of a technical error or likelihood of perioperative thrombosis. Pulsed Doppler spectral analysis was used at operation to measure peak systolic blood flow velocity in the distal graft segment of 83 in situ saphenous vein bypasses to the popliteal (n = 35) or tibial (n = 48) arteries. Blood flow velocities were measured in the smallest diameter graft segment below the knee. Peak systolic blood flow velocity was greater than 40 cm/sec in 77 (93%) of grafts, and no early graft failures occurred. Low blood flow velocity (peak systolic blood flow velocity less than 40 cm/sec) was measured in six bypasses (7%) and was attributed to large (greater than 5 mm) vein diameter, residual hemodynamically significant lesions (intact valve leaflet, proximal arteriovenous fistula), or sclerosed vein segments. With the correction of these abnormalities, the 30 day patency for the entire series was 100%. The measurement of low blood flow velocity in the distal segment of an in situ saphenous vein bypass is an uncommon occurrence and mandates a thorough evaluation of the arterial reconstruction for correctable lesions.
原位大隐静脉旁路移植术后的术中速度波形分析可识别与技术失误的存在或围手术期血栓形成可能性相关的异常血流动力学状况。术中使用脉冲多普勒频谱分析测量了83例原位大隐静脉至腘动脉（n = 35）或胫动脉（n = 48）旁路移植远端移植物节段的收缩期峰值血流速度。在膝关节以下最小直径的移植物节段测量血流速度。77例（93%）移植物的收缩期峰值血流速度大于40 cm/秒，且未发生早期移植物失败。6例旁路移植（7%）测量到低血流速度（收缩期峰值血流速度小于40 cm/秒），其原因是静脉直径大（大于5 mm）、残留有血流动力学意义的病变（完整的瓣膜小叶、近端动静脉瘘）或硬化的静脉节段。纠正这些异常后，整个系列的30天通畅率为100%。原位大隐静脉旁路移植远端节段低血流速度的测量并不常见，需要对动脉重建进行全面评估以寻找可纠正的病变。
