Mills J L, Bandyk D F, Gahtan V, Esses G E
Division of Vascular Surgery, University of South Florida College of Medicine, Tampa.
J Vasc Surg. 1995 Jan;21(1):16-22; discussion 22-5. doi: 10.1016/s0741-5214(95)70240-7.
The purpose of this study was to determine the origin of vein graft lesions and their propensity for progression based on prospective duplex surveillance of 135 infrainguinal vein bypasses.
One hundred sixteen greater saphenous, 13 spliced, five cephalic, and one superficial femoral vein grafts were evaluated by color duplex imaging at surgical procedure, 1 and 6 weeks, 3 and 6 months, and every 3 to 6 months thereafter. Duplex-identified lesions were graded by peak systolic velocity and velocity ratio criteria and were either followed or subjected to revision.
Early postoperative duplex surveillance allowed stratification of infrainguinal grafts into two subsets. Of 91 (67%) grafts with normal early scans (at 3 months), only two (2.2%) developed de novo stenoses (at 6 and 8 months) that required revision. Forty-four grafts with abnormal duplex scans had a focal flow abnormality (peak systolic velocity > 150 cm/sec, velocity ratio > 1.5) in the graft body (n = 24) or anastomotic region (n = 20). In 14 grafts the flow abnormality (mean peak systolic velocity = 217 cm/sec, velocity ratio = 2.3) normalized. Ten additional grafts exhibited a moderate, persistent graft stenosis (mean peak systolic velocity 248 cm/sec, velocity ratio = 3.3) that was not repaired. All 20 grafts with lesions that progressed to high-grade stenosis (mean peak systolic velocity = 362 cm/sec, velocity ratio = 7.2) and were revised had a residual flow abnormality confirmed at operation, or it appeared by 6 weeks. In the entire series six (4.4%) grafts failed during the mean 12-month follow-up interval (range 3 to 30 months), 4 with unrepaired defects and two after revision.
Prospective duplex surveillance verified that de novo graft stenosis was uncommon (< 2.2%) after reversed and in situ saphenous vein bypass grafting. Graft stenoses developed at sites of unrepaired defects or early appearing conduit abnormalities. An early appearing duplex focal flow abnormality warranted careful surveillance, because one half of such sites progressed to a high-grade stenosis. Grafts with normal early duplex scans exhibited a low incidence of stenosis development or occlusion, and thus less intense postoperative surveillance can be recommended.
本研究旨在基于对135例股下静脉搭桥术的前瞻性双功超声监测，确定静脉移植物病变的起源及其进展倾向。
通过彩色双功成像对116例大隐静脉、13例拼接静脉、5例头静脉和1例股浅静脉移植物在手术时、术后1周和6周、3个月和6个月以及此后每3至6个月进行评估。根据收缩期峰值流速和流速比标准对双功超声识别的病变进行分级，并对其进行随访或修正。
术后早期双功超声监测可将股下静脉移植物分为两个亚组。在91例（67%）早期扫描正常（3个月时）的移植物中，只有2例（2.2%）出现了新生狭窄（6个月和8个月时），需要进行修正。44例双功超声扫描异常的移植物在移植物主体（n = 24）或吻合区域（n = 20）出现局灶性血流异常（收缩期峰值流速> 150 cm/秒，流速比> 1.5）。14例移植物的血流异常（平均收缩期峰值流速 = 217 cm/秒，流速比 = 2.3）恢复正常。另外10例移植物表现为中度、持续性移植物狭窄（平均收缩期峰值流速248 cm/秒，流速比 = 3.3），未进行修复。所有20例病变进展为重度狭窄（平均收缩期峰值流速 = 362 cm/秒，流速比 = 7.2）并进行修正的移植物在手术时均证实存在残余血流异常，或在6周时出现。在整个系列中，6例（4.4%）移植物在平均12个月的随访期内（范围3至30个月）失败，4例因未修复的缺陷失败，2例在修正后失败。
前瞻性双功超声监测证实，逆行和原位大隐静脉搭桥术后新生移植物狭窄并不常见（< 2.2%）。移植物狭窄发生在未修复的缺陷部位或早期出现的管道异常部位。早期出现的双功超声局灶性血流异常需要仔细监测，因为这些部位中有一半会进展为重度狭窄。早期双功超声扫描正常的移植物狭窄或闭塞的发生率较低，因此建议术后进行强度较低的监测。
