Beidle T R, Brom-Ferral R, Letourneau J G
Department of Radiology, University of Minnesota Hospital, Minneapolis 55455.
AJR Am J Roentgenol. 1994 Feb;162(2):443-8. doi: 10.2214/ajr.162.2.8310944.
This review considers the relative roles of traditional noninvasive vascular tests and conventional duplex and color flow Doppler sonography in the surveillance of infrainguinal autologous vein grafts. The purpose of surveillance is to identify significant anatomic or flow abnormalities that predispose to thrombosis, but can be repaired before graft thrombosis occurs. Although a few authors believe that serial measurements of the ankle-brachial index and other noninvasive vascular tests can serve as the primary method of surveillance for infrainguinal grafts, most authors do not concur. After the first postoperative month, stenosis caused by intimal hyperplasia is the most common cause of graft failure, usually occurring within 18 months after placement. Duplex sonography is both highly sensitive and specific for detection of such stenoses. Specific duplex sonographic criteria have been established for grading of stenoses and for the diagnosis and classification of arteriovenous fistulas. A large body of evidence suggests that graft thrombosis can occur without prior warning symptoms and that long-term graft patency improves if the asymptomatic lesions detected with duplex sonography are repaired before symptoms develop.
本综述探讨了传统无创血管检查以及传统双功超声和彩色血流多普勒超声在监测股下自体静脉移植物中的相对作用。监测的目的是识别易导致血栓形成的明显解剖或血流异常，以便在移植物血栓形成之前进行修复。尽管一些作者认为，连续测量踝肱指数及其他无创血管检查可作为股下移植物的主要监测方法，但大多数作者并不认同。术后第一个月后，内膜增生导致的狭窄是移植物失败的最常见原因，通常发生在植入后18个月内。双功超声对检测此类狭窄具有高度敏感性和特异性。已制定了特定的双功超声标准用于狭窄分级以及动静脉瘘的诊断和分类。大量证据表明，移植物血栓形成可能没有先兆症状，并且如果在症状出现之前修复双功超声检测到的无症状病变，长期移植物通畅率会提高。
