Harward T R, Bernstein E F, Fronek A
J Vasc Surg. 1987 Jun;5(6):803-13. doi: 10.1067/mva.1987.avs0050803.
Prediction and localization of significant proximal occlusive disease in the lower extremities, whether in isolation or in combination with significant distal disease, still represent major problems to the noninvasive vascular laboratory. Power frequency spectrum analysis (PFSA) was done on continuous-wave Doppler signals in the common femoral artery of 86 limbs in 50 patients before and after postocclusive reactive hyperemia testing in an effort to differentiate hemodynamically significant from insignificant proximal occlusive disease, whether in isolation or in combination with hemodynamically significant distal disease. Limbs were assigned to four different categories according to their angiographic findings. With the use of a bandwidth at 50% peak amplitude (f50%) of 2000 Hz as the cut-off point between a positive and a negative examination, the test was 93% sensitive, 90% specific, and 92% accurate in distinguishing hemodynamically significant proximal lesions from hemodynamically insignificant lesions, regardless of distal disease. In addition, there exists a small group with significant disease at or close to the site of Doppler sampling, which produces f50% values of more than 3000 Hz. Diagnosis in this subgroup was much like that in carotid disorders. Finally, the predictive accuracy of standard noninvasive Doppler/segmental pressure measurement was compared with results of PFSA. In most patients, standard measurements were comparable; however, in the subgroup with hemodynamically significant proximal and distal disease, the PFSA technique accurately predicted hemodynamically significant proximal diseases in 93% of patients, where combined pressure/Doppler testing had an accuracy of only 61%. In all, spectrum analysis of common femoral artery velocity signals can greatly aid in determining the presence or absence of significant proximal disease in all situations.
下肢严重近端闭塞性疾病的预测和定位，无论其是孤立存在还是与严重远端疾病合并存在，对于无创血管实验室而言仍是重大难题。对50例患者86条下肢的股总动脉连续波多普勒信号进行了闭塞后反应性充血试验前后的功率频谱分析（PFSA），以从血流动力学角度区分严重与不严重的近端闭塞性疾病，无论其是孤立存在还是与血流动力学严重的远端疾病合并存在。根据血管造影结果，将下肢分为四类。以2000Hz的50%峰值幅度带宽（f50%）作为阳性和阴性检查的分界点，该试验在区分血流动力学严重的近端病变与血流动力学不严重的病变方面，敏感度为93%，特异度为90%，准确率为92%，无论有无远端疾病。此外，存在一小部分患者，在多普勒采样部位或其附近存在严重疾病，其f50%值超过3000Hz。该亚组的诊断与颈动脉疾病的诊断非常相似。最后，将标准无创多普勒/节段压力测量的预测准确性与PFSA结果进行了比较。在大多数患者中，标准测量结果相当；然而，在血流动力学严重的近端和远端疾病亚组中，PFSA技术在93%的患者中准确预测了血流动力学严重的近端疾病，而联合压力/多普勒测试的准确率仅为61%。总之，股总动脉速度信号的频谱分析在所有情况下都能极大地帮助确定是否存在严重的近端疾病。
