Flanigan D P, Ryan T J, Williams L R, Schwartz J A, Gray B, Schuler J J
J Vasc Surg. 1984 Jan;1(1):215-23. doi: 10.1067/mva.1984.avs0010215.
Proper selection of suprainguinal vs. infrainguinal arterial revascularization in patients with multilevel disease requires hemodynamic assessment. In such patients hemodynamic evaluation of the aortoiliac system cannot be made accurately with either arteriography or current noninvasive techniques. One hundred six lower extremities underwent preoperative triplane arteriography, measurement of Doppler-derived segmental blood pressures, measurement of common femoral intra-arterial pressure, and intra-arterial injection (30 mg) of the vasodilator papaverine hydrochloride prior to arterial bypass. Common femoral intra-arterial pressure was monitored continuously before and after papaverine injection. The resting femoral/brachial pressure index (FBI) and the maximum change in this index (% delta FBI) following papaverine injection were calculated. To be considered improved postoperatively, claudicants required an increase in treadmill walking time of greater than or equal to 50%, whereas patients operated on for limb salvage required an increase in the thigh/brachial pressure index (TBI) of greater than or equal to 0.15 for suprainguinal revascularizations and an increase of TBI to greater than or equal to 0.9 for infrainguinal revascularizations. In the first 41 extremities (phase I), receiver operator characteristic analysis revealed a % delta FBI greater than or equal to 15% to be optimal in the detection of hemodynamically significant aortoiliac disease. In phase II (65 limbs) this discriminant value for % delta FBI was assessed prospectively. In phase I, in which the choice of supra- vs. infrainguinal bypass was determined arteriographically, only 80% of the extremities were improved; in phase II, in which supra- vs. infrainguinal bypass was determined by the papaverine test, 98% of extremities were improved (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
对于患有多节段疾病的患者，在选择腹股沟上动脉与腹股沟下动脉血运重建时，需要进行血流动力学评估。在此类患者中，无论是动脉造影还是目前的非侵入性技术，都无法准确评估主髂动脉系统的血流动力学。106条下肢在进行动脉搭桥术前接受了术前三面动脉造影、多普勒衍生节段血压测量、股总动脉内压力测量以及动脉内注射（30毫克）血管扩张剂盐酸罂粟碱。在注射罂粟碱前后持续监测股总动脉内压力。计算静息股/肱压力指数（FBI）以及注射罂粟碱后该指数的最大变化（%ΔFBI）。为了被认为术后有所改善，间歇性跛行患者的跑步机行走时间需增加大于或等于50%，而接受保肢手术的患者，对于腹股沟上血运重建，大腿/肱压力指数（TBI）需增加大于或等于0.15，对于腹股沟下血运重建，TBI需增加到大于或等于0.9。在最初的41条肢体（第一阶段）中，受试者工作特征分析显示，%ΔFBI大于或等于15%在检测血流动力学显著的主髂动脉疾病方面最为理想。在第二阶段（65条肢体），对该%ΔFBI判别值进行了前瞻性评估。在第一阶段，腹股沟上与腹股沟下旁路的选择通过动脉造影确定，只有80%的肢体得到改善；在第二阶段，腹股沟上与腹股沟下旁路的选择通过罂粟碱试验确定，98%的肢体得到改善（p<0.01）。（摘要截断于250字）
