Bandyk D F, Cato R F, Towne J B
Surgery. 1985 Oct;98(4):799-809.
The prognostic value of Doppler-derived blood flow velocity measurements for predicting the patency of femoropopliteal and femorotibial bypass grafts was analyzed. Peak systolic and end-diastolic blood flow velocities were measured in 42 femorotibial, 24 femoropopliteal, and three femoropopliteal (isolated segment) in situ saphenous vein bypasses at operation and serially in the postoperative period. At operation peak systolic flow velocity was greater (p less than 0.01) in femoropopliteal grafts (90 +/- 22 cm/sec) compared with femorotibial grafts (68 +/- 19 cm/sec) and isolated segment femoropopliteal (58 +/- 16 cm/sec) grafts. Diastolic forward flow, indicative of low outflow resistance, was present in all successful grafts at operation and in the immediate postoperative period, but decreased thereafter. Early graft occlusion was associated with a low peak systolic flow velocity (less than 40 cm/sec) and absent diastolic forward flow. Postoperative decrease in peak systolic velocity to less than 45 cm/sec identified grafts with impending failure due to intrinsic graft lesions or progression of atherosclerosis. A low blood flow velocity threatens graft patency and should prompt an angiographic evaluation to identify correctable graft lesions or an outflow tract suitable for sequential grafting for the purpose of augmenting flow velocity.
分析了多普勒衍生的血流速度测量对预测股腘和股胫旁路移植血管通畅情况的预后价值。在手术时及术后连续测量了42例股胫、24例股腘和3例股腘（孤立节段）原位大隐静脉旁路移植血管的收缩期峰值和舒张末期血流速度。手术时，股腘移植血管的收缩期峰值血流速度（90±22cm/秒）高于股胫移植血管（68±19cm/秒）和孤立节段股腘移植血管（58±16cm/秒）（p＜0.01）。舒张期正向血流表明流出阻力低，在所有成功的移植血管手术时及术后即刻均存在，但此后降低。早期移植血管闭塞与收缩期峰值血流速度低（＜40cm/秒）和舒张期正向血流缺失有关。术后收缩期峰值速度降至＜45cm/秒可识别出因移植血管固有病变或动脉粥样硬化进展而即将失败的移植血管。低血流速度会威胁移植血管通畅，应促使进行血管造影评估，以识别可纠正的移植血管病变或适合进行序贯移植以增加血流速度的流出道。
