Timina I E, Askerova N N, Karmazanovskiĭ G G, Piatkova I I, Zotikov A E
Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health, Moscow, Russia; First Moscow State Medical University named after I.M.Sechenov under the RF Ministry of Public Health, Moscow, Russia.
Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health, Moscow, Russia.
Angiol Sosud Khir. 2018;24(2):41-48.
The introduction into clinical practice of contrast-enhanced ultrasonographic examination made it possible to assess patency of tibial arteries and perfusion of crural muscles in patients with occlusive lesions of lower-limb arteries. These findings are important for planning optimal treatment policy and assessing efficacy of operative or medicamentous treatment.
The study was aimed at investigating a possibility of contrast-enhanced ultrasound examination for assessment of patency of tibial arteries and quantitative assessment of perfusion of crural muscles in patient with occlusive lesions of lower-limb arteries.
We examined a total of 30 patients presenting with atherosclerotic-genesis occlusive lesions of lower limb arteries and symptomatic intermittent claudication. Five patients were examined in the postoperative period. All patients were subjected to quantitative analysis of crural muscle perfusion in the pre- and postoperative periods, determining the time of onset of contrast medium accumulation and the time to the peak of intensity.
Contrast-enhanced ultrasound examination demonstrated that in patients with occlusive lesions of lower-limb arteries the start of contrast medium accumulation appeared to occur later than in apparently healthy people: on second 30-88, depending on the degree of limb ischaemia. The contrasting time-to-peak was also increased (from 36 to 120 s). In the postoperative period all patients were found to have improved perfusion of the crural muscles, which was confirmed by a decrease in time-to-peak contrasting.
Contrast-enhanced ultrasonographic examination is currently the only non-invasive, safe method of determining perfusion of crural muscles, which may be used many times for assessment of viability of the ischaemised extremity, as well as for assessment of efficacy of the treatment performed.
超声造影检查引入临床实践后，使得评估下肢动脉闭塞性病变患者的胫动脉通畅情况及小腿肌肉灌注情况成为可能。这些发现对于制定最佳治疗方案以及评估手术或药物治疗的疗效具有重要意义。
本研究旨在探讨超声造影检查评估下肢动脉闭塞性病变患者胫动脉通畅情况及定量评估小腿肌肉灌注的可能性。
我们共检查了30例患有动脉粥样硬化性下肢动脉闭塞性病变且有症状性间歇性跛行的患者。其中5例患者在术后进行了检查。所有患者在术前和术后均接受了小腿肌肉灌注的定量分析，测定造影剂开始积聚的时间和强度峰值时间。
超声造影检查显示，下肢动脉闭塞性病变患者造影剂开始积聚的时间比明显健康的人要晚：根据肢体缺血程度，在第30 - 88秒之间。造影剂达到峰值的时间也延长了（从36秒至120秒）。术后所有患者小腿肌肉灌注均有所改善，这通过造影剂达到峰值时间的缩短得到证实。
超声造影检查是目前唯一一种用于确定小腿肌肉灌注的非侵入性、安全的方法，可多次用于评估缺血肢体的存活能力以及所实施治疗的疗效。
