Bandyk D F, Kaebnick H W, Bergamini T M, Moldenhauer P, Towne J B
Department of Surgery, Medical College of Wisconsin, Milwaukee.
Arch Surg. 1988 Apr;123(4):477-82. doi: 10.1001/archsurg.1988.01400280087016.
Doppler-derived blood flow velocity and limb blood pressure measurements were used to characterize the hemodynamics of 128 in situ saphenous vein arterial bypasses. The magnitude and configuration of the graft velocity waveform was the best predictor of clinical outcome. Successful bypasses had antegrade flow throughout the pulse cycle and a blood flow velocity above 40 cm/s. A low graft blood flow velocity (less than 40 cm/s) was associated with technical error or early graft failure due to poor runoff. The return of normal limb blood pressure correlated with a technically satisfactory bypass but was measured in only 50% of limbs on the first day after surgery. In 28 bypasses with high blood flow velocity (mean +/- SD) in systole (102 +/- 20 cm/s) and diastole (35 +/- 11 cm/s), postoperative limb blood pressure was initially low (mean ankle-brachial pressure index = 0.68) due to restriction of blood flow through small-diameter (less than 4-mm) venous conduits. As revascularization hyperemia abated, diastolic blood flow velocity decreased and limb blood pressure normalized. Despite the high blood flow velocity and pressure gradient associated with flow-restrictive venous conduits, limb ischemic symptoms resolved, and graft patency was not decreased. An understanding of graft and limb hemodynamics after in situ bypass grafting is critical when noninvasive diagnostic techniques are used to document technical adequacy and for postoperative surveillance.
采用多普勒衍生的血流速度和肢体血压测量来描述128例原位大隐静脉动脉搭桥术的血流动力学特征。移植血管速度波形的幅度和形态是临床结果的最佳预测指标。成功的搭桥术在整个脉搏周期中均有正向血流，且血流速度高于40 cm/s。移植血管血流速度低（低于40 cm/s）与技术失误或因流出道不佳导致的早期移植血管失败相关。肢体血压恢复正常与技术上满意的搭桥术相关，但术后第一天仅在50%的肢体中测得。在28例收缩期（102±20 cm/s）和舒张期（35±11 cm/s）血流速度高的搭桥术中，术后肢体血压最初较低（平均踝肱压力指数=0.68），这是由于通过小直径（小于4 mm）静脉导管的血流受限所致。随着再灌注充血减轻，舒张期血流速度降低，肢体血压恢复正常。尽管与血流限制性静脉导管相关的血流速度高和压力梯度大，但肢体缺血症状得到缓解，移植血管通畅率并未降低。当使用非侵入性诊断技术来记录技术是否充分以及进行术后监测时，了解原位搭桥术后移植血管和肢体的血流动力学至关重要。
