Timina I E, Piatkova I I, Zotikov A E, Adyrkhaev Z A
Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health, Moscow, Russia.
Russian Medical Academy of Postgraduate Education of the RF Public Health Ministry, Moscow, Russia.
Angiol Sosud Khir. 2017;23(1):51-58.
The study was aimed at assessing diagnostic possibilities of duplex scanning (DS) of lower limb arteries, used as 'ultrasonographic angiography' in patients presenting with critical ischaemia for appropriately planning complicated infrainguinal reconstructions at stages of surgical management, including dynamic follow up in the postoperative period.
We examined a total of 30 patients. Of these, 14 patients composed the control group and 16 patients with critical ischaemia of lower limb arteries who underwent 8 external iliac-tibial and 8 femorotibial bypass graftings with a relieving arteriovenous fistula and application of a venous cuff according to the type of 'St. Mary's boot'. All the 16 patients preoperatively underwent DS of lower limb arteries and CT angiography, as well as postoperative DS of the vessels of the zone of the operative intervention. We compared the possibilities of DS and CT angiography in the assessment of the state of various segments of lower limb arteries. The obtained findings were compared with the data of the 'golden standard' - X-ray contrast enhanced angiography or intraoperative revision.
In assessing the state of the aortoiliac segment, sensitivity and specificity of the both methods amounted to 100%. In assessing patency of the femoropopliteal segment, sensitivity and specificity of DS amounted to 93.7 and 100%, with those for CT angiography equalling 87.5 and 100%. Assessing patency of arteries of the crus, sensitivity and specificity of the both methods amounted to 87.5 and 93.7%, respectively. In the postoperative period it was revealed that a prognostically favourable factor for shunt functioning is the value of the volumetric velocity of blood flow in the shunt at the level of the middle third of the femur, equalling the sum of volumetric velocities of blood flow in the donor artery distal to and in the relieving vein proximal to the anastomosis. Important prognostic parameters of shunt functioning were also the values of linear velocity of blood flow both in the shunt and donor artery.
Strict compliance with the methodology and protocol of DS makes it possible to evaluate the condition of outflow pathways while planning the intervention, to assess functioning of the shunt in the postoperative period and to work out criteria for favourable functioning of the infrainguinal shunt for regular dynamic control over the state of the revascularized limb.
本研究旨在评估下肢动脉双功超声扫描（DS）作为“超声血管造影”的诊断可能性，用于为严重缺血患者在手术管理阶段适当规划复杂的腹股沟下重建手术，包括术后动态随访。
我们共检查了30例患者。其中，14例患者组成对照组，16例下肢动脉严重缺血患者接受了8例髂外-胫动脉和8例股-胫动脉搭桥手术，并根据“圣玛丽靴”类型建立了缓解动静脉瘘并应用静脉袖带。所有16例患者术前均接受了下肢动脉DS和CT血管造影，以及手术干预区域血管的术后DS。我们比较了DS和CT血管造影在评估下肢动脉各节段状态方面的可能性。将获得的结果与“金标准”——X线造影增强血管造影或术中检查的数据进行比较。
在评估主-髂动脉节段状态时，两种方法的敏感性和特异性均达到100%。在评估股-腘动脉节段通畅情况时，DS的敏感性和特异性分别为93.7%和100%，CT血管造影的敏感性和特异性分别为87.5%和100%。在评估小腿动脉通畅情况时，两种方法的敏感性和特异性分别为87.5%和93.7%。在术后期间发现，分流功能的一个预后有利因素是股骨中三分之一水平分流处的血流容积速度值，等于吻合口远端供血动脉和近端缓解静脉中的血流容积速度之和。分流功能的重要预后参数还包括分流和供血动脉中的血流线性速度值。
严格遵守DS的方法和方案能够在规划干预时评估流出道情况，评估术后分流功能，并制定腹股沟下分流良好功能的标准，以便对血管重建肢体的状态进行定期动态监测。
