Mohan C R, Hoballah J J, Schueppert M T, Sharp W J, Kresowik T F, Miller E V, Corson J D
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.
Arch Surg. 1995 May;130(5):483-7; discussion 487-8. doi: 10.1001/archsurg.1995.01430050033004.
To evaluate the need for color duplex surveillance (CDS) for pure in situ bypasses beyond 6 months.
We reviewed our in situ surveillance data from August 1987 to April 1994. Lower-extremity revascularization was performed using 245 pure in situ greater saphenous vein bypasses in 219 patients. The CDS of the entire bypass and inflow and outflow arteries was done prior to discharge, at 1 month, every 3 months in the first year, every 6 months in the second year, and annually thereafter. A peak systolic velocity of less than 45 cm/s throughout the bypass or a velocity ratio of greater than 3 (peak systolic velocity at the stenosis divided by peak systolic velocity at an adjacent normal bypass segment) were defined as abnormal during the review of this patient subset. The outcomes were analyzed. Patency and limb salvage rates were calculated by life-table analysis.
The mean age of this population (120 men and 99 women) was 67 years (range, 32 to 97 years). We analyzed all bypasses that were subjected to CDS for 6 months or more and identified 171 such bypasses. These bypasses were followed up for a mean duration of 30 months (range, 6 to 82 months).
The primary and secondary patency and limb salvage rates at 5 years were 60.4%, 89%, and 92.1%, respectively (SE, < 10%). During the first 6 months of surveillance, 54 bypasses had abnormal CDS findings, and 117 had normal CDS findings. Arteriography was performed on 42 of these bypasses with abnormal CDS findings, and 37 had significant findings requiring direct surgical or endovascular intervention. Only two of 117 bypasses that had normal CDS findings for up to 6 months had to be revised later, compared with 43 of the 54 bypasses with abnormal CDS findings prior to 6 months, which were occluded or were revised (significantly different by chi 2 test [P < .001]).
Vigorous CDS of pure in situ bypasses for up to 6 months is useful to detect bypass-threatening lesions. Continued CDS of a normal in situ bypass after 6 months may not be justifiable, as the incidence of lesions requiring later revision is minimal.
评估6个月以上单纯原位旁路移植术后彩色双功能超声监测（CDS）的必要性。
回顾1987年8月至1994年4月期间的原位监测数据。对219例患者进行了245例单纯原位大隐静脉下肢血管重建术。在出院前、术后1个月、第一年每3个月、第二年每6个月以及此后每年对整个旁路移植血管及其流入和流出动脉进行CDS检查。在对该患者亚组的回顾中，将整个旁路移植血管的收缩期峰值流速小于45 cm/s或流速比值大于3（狭窄处收缩期峰值流速除以相邻正常旁路移植血管段的收缩期峰值流速）定义为异常。分析结果。通过寿命表分析计算通畅率和肢体挽救率。
该人群（120名男性和99名女性）的平均年龄为67岁（范围32至97岁）。我们分析了所有接受CDS检查6个月或更长时间的旁路移植血管，共识别出171条此类旁路移植血管。这些旁路移植血管的平均随访时间为30个月（范围6至82个月）。
5年时的初次通畅率、二次通畅率和肢体挽救率分别为60.4%、89%和92.1%（标准误，<10%）。在监测的前6个月，54条旁路移植血管的CDS检查结果异常，117条结果正常。对其中42条CDS检查结果异常的旁路移植血管进行了动脉造影，37条有需要直接手术或血管腔内干预的显著病变。在6个月内CDS检查结果一直正常的117条旁路移植血管中，只有2条后来需要进行翻修，而在6个月前CDS检查结果异常的54条旁路移植血管中有43条发生闭塞或进行了翻修（经卡方检验差异有统计学意义[P<.001]）。
对单纯原位旁路移植血管进行长达6个月的积极CDS检查有助于发现威胁旁路移植血管的病变。6个月后对正常原位旁路移植血管继续进行CDS检查可能不合理，因为需要后期翻修的病变发生率极低。
