Troutman Douglas A, Madden Nicholas J, Dougherty Matthew J, Calligaro Keith D
Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
J Vasc Surg. 2014 Dec;60(6):1580-4. doi: 10.1016/j.jvs.2014.08.071. Epub 2014 Sep 22.
We previously showed that duplex ultrasound (DU) imaging is beneficial in the diagnosis of failing vein and prosthetic grafts performed for arterial occlusive disease. The purpose of this study was to evaluate whether DU imaging can reliably diagnose failing stent grafts (ie, covered stents) placed for arterial occlusive disease.
Between July 1, 2005, and June 30, 2013, we placed 142 stent grafts in 92 arterial segments (1.5 stent grafts/stenotic artery) for lower extremity occlusive disease in patients who also underwent at least one DU surveillance study documenting a patent stent graft. Stent grafts were placed in 29 iliac and 52 femoropopliteal arteries and in 11 failing infrainguinal bypass grafts. Stent grafts used were Viabahn (W. L. Gore and Associates Inc, Flagstaff, Ariz) in 116 (82%), Wallgraft (Boston Scientific, Natick, Mass) in 23 (16%), Fluency (C. R. Bard Inc, Tempe, Ariz) in 2 (1%), and iCast (Atrium, Hudson, NH) in 1 (1%). Mean follow-up was 16 months (range, 1 week-86 months). Postoperative DU surveillance was performed in our Intersocietal Accreditation Commission accredited noninvasive vascular laboratory at 1 week, then every 3 months the first year, and every 6 months thereafter. DU measured peak systolic velocities (PSVs) and velocity ratio of adjacent PSVs (Vr) every 5 cm within the stent graft and adjacent arteries.
We retrospectively classified the following factors as "abnormal DU findings:" focal PSVs >300 cm/s, uniform PSVs <50 cm/s throughout the graft, and a Vr >3.0. Fifteen of 20 patients with one or more of these abnormal DU findings underwent prophylactic intervention (n = 8) or occluded without intervention (n = 7), whereas only two of 72 with normal DU findings occluded (P = .0001). Excluding the eight patients who underwent prophylactic intervention, seven of 12 patients with abnormal DU findings occluded without intervention vs two of 72 with normal DU findings (P = .0001).
These findings suggest that follow-up DU surveillance can predict failure of stent grafts placed for lower extremity occlusive disease. Focal PSVs >300 cm/s, Vr >3.0, and most importantly, uniform PSVs <50 cm/s throughout the stent graft were statistically reliable markers for predicting stent graft thrombosis.
我们之前表明，双功超声（DU）成像有助于诊断因动脉闭塞性疾病而进行的静脉和人工血管移植失败情况。本研究的目的是评估DU成像能否可靠地诊断用于动脉闭塞性疾病的覆膜支架移植失败（即覆膜支架）。
在2005年7月1日至2013年6月30日期间，我们在92个动脉节段中植入了142个覆膜支架（每个狭窄动脉植入1.5个覆膜支架）用于治疗下肢闭塞性疾病，这些患者还至少接受了一次记录覆膜支架通畅的DU监测研究。覆膜支架分别植入29条髂动脉、52条股腘动脉以及11条失败的腹股沟下搭桥血管。使用的覆膜支架中，116个（82%）为Viabahn（WL Gore and Associates Inc，弗拉格斯塔夫，亚利桑那州），23个（16%）为Wallgraft（波士顿科学公司，纳蒂克，马萨诸塞州），2个（1%）为Fluency（CR Bard Inc，坦佩，亚利桑那州），1个（1%）为iCast（Atrium，哈德逊，新罕布什尔州）。平均随访时间为16个月（范围：1周 - 86个月）。术后DU监测在我们经社会间认证委员会认可的非侵入性血管实验室进行，术后1周进行，然后在第一年每3个月进行一次，此后每6个月进行一次。DU在覆膜支架及其相邻动脉内每隔5厘米测量收缩期峰值流速（PSV）和相邻PSV的流速比值（Vr）。
我们将以下因素回顾性分类为“异常DU表现”：局部PSV > 300 cm/s、整个移植物内PSV均一 < 50 cm/s以及Vr > 3.0。20例有一项或多项这些异常DU表现的患者中，15例接受了预防性干预（n = 8）或未干预而闭塞（n = 7），而72例DU表现正常的患者中只有2例闭塞（P = .0001）。排除接受预防性干预的8例患者后，12例有异常DU表现的患者中有7例未干预而闭塞，而72例DU表现正常的患者中有2例闭塞（P = .0001）。
这些结果表明，随访DU监测可以预测用于下肢闭塞性疾病的覆膜支架移植失败。局部PSV > 300 cm/s、Vr > 3.0，最重要的是，整个覆膜支架内PSV均一 < 50 cm/s是预测覆膜支架血栓形成的统计学可靠指标。
