O'Brien T S, Thomas H, Crow A, Lamont P M
Oxford Regional Vascular Unit, John Radcliffe Hospital, U.K.
Eur J Vasc Surg. 1993 Mar;7(2):177-9. doi: 10.1016/s0950-821x(05)80759-5.
Previous angiographic and radiological studies have suggested that the peroneal artery is the best preserved of the calf vessels in peripheral vascular disease and should be a site of preference for a femorodistal bypass graft. Calf vessel run-off assessed by pulse generated run-off (PGR) provides a more accurate prediction of graft success or failure than angiography and may therefore give a better functional picture of vessel patency than angiography. This study compares the presence and degree of preservation of the three calf vessels in patients with severe peripheral vascular disease using both intra-arterial digital subtraction angiography (IADSA) and PGR. Thirty-four limbs in patients with either ischaemic rest pain, ulceration or gangrene were studied and the results were scored according to the extent and severity of disease in the peroneal, posterior tibial and anterior tibial arteries. On IADSA, the peroneal artery was patent significantly more often (79%) than the posterior tibial artery (47%) or the anterior tibial artery (38%). Conversely, PGR examination showed no difference in patency between the three vessels (peroneal 91%, posterior tibial 88%, anterior tibial 79%). The peroneal artery was also significantly better preserved on IADSA (65%) compared to the posterior tibial artery (38%) and the anterior tibial artery (23%). PGR studies again showed no difference in the best preserved vessel between peroneal (47%), posterior tibial (50%) and anterior tibial (50%) arteries. Thus, the peroneal artery appears the better preserved vessel on angiography but this appearance may be misleading because the more functional PGR studies show no significant difference in the patency or degree of preservation of the three calf vessels.
以往的血管造影和放射学研究表明，在周围血管疾病中，腓动脉是小腿血管中保存最好的，应优先作为股-远端旁路移植的部位。通过脉冲血流（PGR）评估的小腿血管流出情况比血管造影能更准确地预测移植的成功或失败，因此可能比血管造影能更好地反映血管通畅的功能情况。本研究使用动脉内数字减影血管造影（IADSA）和PGR比较了严重周围血管疾病患者三条小腿血管的存在情况和保存程度。对34例患有静息痛、溃疡或坏疽的患者的肢体进行了研究，并根据腓动脉、胫后动脉和胫前动脉疾病的范围和严重程度对结果进行评分。在IADSA上，腓动脉通畅的比例（79%）明显高于胫后动脉（47%）或胫前动脉（38%）。相反，PGR检查显示三条血管的通畅情况没有差异（腓动脉91%，胫后动脉88%，胫前动脉79%）。与胫后动脉（38%）和胫前动脉（23%）相比，IADSA显示腓动脉的保存情况也明显更好（65%）。PGR研究再次显示，腓动脉（47%）、胫后动脉（50%）和胫前动脉（50%）之间在保存最好的血管方面没有差异。因此，在血管造影上腓动脉似乎是保存较好的血管，但这种表现可能会产生误导，因为功能更强的PGR研究显示，三条小腿血管的通畅情况或保存程度没有显著差异。
