Tong Y, Royle J
Vascular Surgery Unit, Austin Hospital, Heidelberg, Victoria, Australia.
Aust N Z J Surg. 1994 Oct;64(10):684-7. doi: 10.1111/j.1445-2197.1994.tb02057.x.
The contribution of duplex scanning to improving early diagnosis of graft stenosis was evaluated in 195 patients after infrainguinal bypass procedures. Over a 31 month period. 406 duplex scans were obtained on 232 limbs with 191 vein and 41 polytetrafluoroethylene (PTFE) grafts. Peak systolic velocities > 200 cm/s with spectral broadening and lumen reduction on B-mode image were the criteria adopted for identification of a haemodynamically significant (> 50%) stenosis. Sixty-one stenoses were identified in 55 of the grafted limbs. Thirty-three of the 55 limbs had a subsequent angiogram. The angiogram showed graft occlusion in six limbs, graft stenosis in 18, and native artery stenosis in four. Twenty-one of the grafts had the angiogram within 1 month after the duplex had detected graft stenosis, and one (4.76%) became occluded in this interval. Seven had an angiogram more than 1 month after the duplex study, and five (71.4%) had become occluded. The angiographic study did not confirm a graft stenosis in five limbs. Three were submitted to operation and stenosis was confirmed. Seventeen graft thromboses were detected by duplex scanning. Graft thrombosis was demonstrated following a previous negative duplex scan in one of the 106 vein grafts (0.94%), and in four of 30 PTFE grafts (13.3%). Duplex scanning is effective in the detection of graft stenosis. The precise anatomical location is less accurate when in the region of an anastomosis. Early attention should be taken when duplex studies suggest critical stenosis because there is a high risk of occlusion. Polytetrafluoroethylene grafts tend to thrombose without a precursory focal stenosis.
在195例接受股下旁路手术后的患者中，评估了双功扫描对改善移植血管狭窄早期诊断的作用。在31个月的时间里，对232条肢体进行了406次双功扫描，其中191条为静脉移植血管，41条为聚四氟乙烯（PTFE）移植血管。以收缩期峰值速度>200 cm/s、频谱增宽以及B超图像上管腔缩小作为识别血流动力学显著（>50%）狭窄的标准。在55条移植肢体中发现了61处狭窄。55条肢体中有33条随后进行了血管造影。血管造影显示6条肢体移植血管闭塞，18条移植血管狭窄，4条自体动脉狭窄。21条移植血管在双功扫描检测到移植血管狭窄后1个月内进行了血管造影，其中1条（4.76%）在此期间闭塞。7条在双功扫描检查1个月后进行了血管造影，5条（71.4%）已闭塞。血管造影检查未证实5条肢体存在移植血管狭窄。其中3条接受了手术，证实存在狭窄。双功扫描检测到17例移植血管血栓形成。在106条静脉移植血管中有1条（0.94%）以及30条PTFE移植血管中有4条（13.3%）在先前双功扫描为阴性后出现了移植血管血栓形成。双功扫描在检测移植血管狭窄方面有效。在吻合口区域时，精确的解剖定位不太准确。当双功扫描提示严重狭窄时应尽早关注，因为闭塞风险很高。聚四氟乙烯移植血管往往在没有先兆性局灶性狭窄的情况下发生血栓形成。
