Bandyk D F, Seabrook G R, Moldenhauer P, Lavin J, Edwards J, Cato R, Towne J B
Department of Surgery, Medical College of Wisconsin, Milwaukee.
J Vasc Surg. 1988 Dec;8(6):688-95.
The hemodynamics of 56 femorodistal saphenous vein bypasses (in situ [n = 53] or reversed [n = 3]) identified to have residual or recurrent graft stenoses were characterized with Doppler-derived blood flow velocity and resting limb systolic pressure measurements. The magnitude and configuration of the graft blood flow velocity waveform were the best predictors of graft stenosis. Transformation of the graft blood flow velocity waveform from a triphasic to a monophasic or biphasic configuration coupled with a low (less than 45 cm/sec) or decrease (greater than 30 cm/sec) in peak systolic blood flow velocity relative to initial postoperative levels reliably predicted the presence of a remote occlusive lesion. In 20 (36%) of the 56 limbs, the ankle-brachial systolic pressure index (ABI) did not identify graft stenosis. The low sensitivity of ABI in the identification of graft stenosis was due to insignificant decrease (less than 0.15) of ABI (n = 11), incompressibility of the tibial arteries (n = 6), or residual occlusive lesions after surgery (n = 3). Duplex scanning of grafts with low blood flow velocity localized the site of stenosis in 31 (86%) of 36 patients examined. Graft revision increased systolic blood flow velocity from 33 +/- 9 to 77 +/- 18 cm/sec (mean +/- one standard deviation) a velocity similar to immediate postoperative levels (74 +/- 17 cm/sec). Resting ABI increased from 0.61 +/- 0.2 to 0.92 +/- 0.1 after graft revision. Four grafts with low systolic blood flow velocity (range 18 to 40 cm/sec) not revised occluded 5 to 45 days later.(ABSTRACT TRUNCATED AT 250 WORDS)
对56条已确定存在残余或复发性移植血管狭窄的股-远端大隐静脉旁路移植血管（原位移植[n = 53]或翻转移植[n = 3]）的血流动力学特征进行了研究，采用多普勒测量血流速度并测量静息肢体收缩压。移植血管血流速度波形的幅度和形态是移植血管狭窄的最佳预测指标。移植血管血流速度波形从三相转变为单相或双相形态，同时收缩期峰值血流速度相对于术后初期水平较低（低于45厘米/秒）或下降（大于30厘米/秒），可可靠地预测远处闭塞性病变的存在。在56条肢体中的20条（36%）中，踝臂收缩压指数（ABI）未识别出移植血管狭窄。ABI在识别移植血管狭窄方面的低敏感性是由于ABI下降不显著（小于0.15）（n = 11）、胫动脉不可压缩（n = 6）或术后存在残余闭塞性病变（n = 3）。对血流速度较低的移植血管进行双功扫描，在36例接受检查的患者中的31例（86%）中定位了狭窄部位。移植血管修复使收缩期血流速度从33±9厘米/秒增加到77±18厘米/秒（平均值±一个标准差），该速度与术后即刻水平（74±17厘米/秒）相似。移植血管修复后，静息ABI从0.61±0.2增加到0.92±0.1。4条未进行修复的收缩期血流速度较低（范围为18至40厘米/秒）的移植血管在5至45天后闭塞。（摘要截短于250字）
