Mills J L, Harris E J, Taylor L M, Beckett W C, Porter J M
Vascular Surgery Service, Wilford Hall USAF Medical Center/SGHSG, Lackland AFB, TX 78236-5300.
J Vasc Surg. 1990 Oct;12(4):379-86; discussion 387-9.
To assess the utility of routine duplex surveillance, 379 infrainguinal reversed vein grafts performed at two independent teaching hospitals were prospectively entered into a surveillance protocol from March 1986 through August 1989. An average of 3.2 postoperative duplex graft flow velocity (GFV) measurements per graft was obtained during a mean follow-up interval of 21 1/2 months. Only 2.1% of 280 grafts with GFV measurements greater than 45 cm/sec failed within 6 months of a normal surveillance examination. GFV measurements less than 45 cm/sec in 99 grafts led to arteriography in 75 grafts, identifying 50 stenotic lesions in 48 bypasses (12.6% of series). Inflow lesions were present in 5%, outflow stenoses in 2%, and intrinsic graft stenoses in only 6% of bypasses. Only 29% of grafts identified as failing by duplex scan were associated with a reduction in ankle-brachial index of greater than 0.15. Secondary reconstructions were performed in 48 grafts based on detection of a reduced GFV measurement; all such reconstructions are patent after a mean follow-up of 5 months. Duplex surveillance is more reliable in identification of failing vein grafts than is determination of ankle-brachial index.
为评估常规双功超声监测的效用，1986年3月至1989年8月期间，在两家独立的教学医院进行的379例股下静脉转流移植术被前瞻性纳入监测方案。在平均21.5个月的随访期间，每例移植血管平均进行了3.2次术后双功超声移植血管流速（GFV）测量。在280例GFV测量值大于45 cm/秒的移植血管中，只有2.1%在正常监测检查后6个月内出现失败。99例GFV测量值小于45 cm/秒的移植血管中有75例进行了动脉造影，在48例旁路移植血管中发现了50处狭窄病变（占该系列的12.6%）。流入道病变占5%，流出道狭窄占2%，移植血管本身狭窄仅占旁路移植血管的6%。双功超声扫描确定为失败的移植血管中，只有29%与踝肱指数降低大于0.15有关。基于GFV测量值降低的检测，对48例移植血管进行了二次重建；所有此类重建在平均随访5个月后均保持通畅。与踝肱指数的测定相比，双功超声监测在识别失败的静脉移植血管方面更可靠。
