Stikovac M, Talley J D
Section of Invasive and Interventional Cardiology, University of Louisville School of Medicine, Kentucky, USA.
J Ultrasound Med. 1995 Mar;14(3):211-5. doi: 10.7863/jum.1995.14.3.211.
To correlate angiographic stenoses, pressure gradients, and intravascular Doppler velocity measurements, we studied 12 patients with failing hemodialysis shunts who were undergoing percutaneous transluminal angioplasty. Seven patients had a stenosis at the site of venous anastomosis, two had a stenosis of the central vein, and three had stenoses at both sites. The mean degree of angiographic stenosis was reduced by percutaneous transluminal angioplasty from 74 +/- 8% to 23 +/- 7% diameter, and the mean pressure gradient was reduced from 48 +/- 13 to 7 +/- 3 mm Hg. The proximal to distal peak systolic velocity ratio was significantly different before and after the angioplasty (3.3 +/- 1.4 and 1.6 +/- 0.6, respectively, P < 0.001). The lesion to proximal peak systolic velocity ratio was 2.5 +/- 0.8 before and 1.2 +/- 0.2 after percutaneous transluminal angioplasty (P < 0.001). Cutoff values of 1.9 for the proximal to distal velocity ratio and 1.5 for lesion to proximal velocity ratio were used to assess hemodynamic significance of lesions in our series. Velocity gradients derived from intravascular Doppler measurements correlate with angiographic and pressure measurements in failing hemodialysis shunts treated with percutaneous transluminal angioplasty. Further studies are needed to assess the exact role of these measurements in percutaneous revascularization procedures.
为了关联血管造影狭窄、压力梯度和血管内多普勒速度测量值，我们研究了12例正在接受经皮腔内血管成形术的血液透析分流失败患者。7例患者在静脉吻合部位有狭窄，2例有中心静脉狭窄，3例在两个部位均有狭窄。经皮腔内血管成形术后，血管造影显示的平均狭窄程度从直径的74±8%降至23±7%，平均压力梯度从48±13降至7±3 mmHg。血管成形术前和术后，近端与远端收缩期峰值速度比有显著差异（分别为3.3±1.4和1.6±0.6，P<0.001）。经皮腔内血管成形术前和术后，病变处与近端收缩期峰值速度比分别为2.5±0.8和1.2±0.2（P<0.001）。在我们的系列研究中，近端与远端速度比的截断值为1.9，病变处与近端速度比的截断值为1.5，用于评估病变的血流动力学意义。血管内多普勒测量得出的速度梯度与经皮腔内血管成形术治疗的血液透析分流失败患者的血管造影和压力测量值相关。需要进一步研究以评估这些测量在经皮血管重建手术中的确切作用。
