Legemate D A, Teeuwen C, Hoeneveld H, Eikelboom B C
Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
J Vasc Surg. 1993 Apr;17(4):676-84.
The current diagnostic criteria used to assess the severity of stenoses in the aortoiliac arteries by duplex scanning are mainly based on information related to changes in cross-sectional area and are flow independent. Consequently, duplex scanning fails to detect approximately one quarter of hemodynamically significant aortoiliac lesions compared with intraarterial pressure measurements. The aim of this study is to improve the assessment of the hemodynamic significance of aortoiliac lesions by duplex scanning.
A prospective study in 60 patients was performed in which duplex scanning at rest was compared with intraarterial pressure measurements before and after the administration of papaverine. A simplified Bernoulli equation was used to calculate pressure gradients across stenoses (delta PBern). Two flow-related parameters, the increase in peak systolic velocity (delta PSV) across the stenosis and the end-diastolic velocity at the site of the stenosis, were also measured and compared with intraarterial pressure measurements.
delta PBern and delta PSV showed a sensitivity and specificity of 81% and 88%, respectively, for the detection of hemodynamically significant lesions at rest. However, delta PBern could often not give an accurate calculation of the pressure gradient. Receiver operator characteristic analysis showed that a cut-off level for delta PSV in the range of 1.4 to 1.5 m/s was best able to detect significant lesions at rest. The end-diastolic velocity parameter had a limited diagnostic value.
Although useful in clinical decision making, delta PBern often could not give an accurate calculation of the pressure gradient. delta PSV is a simple and practical spectral analysis parameter to differentiate between significant and insignificant stenoses. This parameter also has the potential to detect hemodynamically less critical lesions if duplex scanning is performed under conditions of increased flow. Further evaluation is needed.
目前通过双功扫描评估主髂动脉狭窄严重程度的诊断标准主要基于与横截面积变化相关的信息，且与血流无关。因此，与动脉内压力测量相比，双功扫描未能检测出约四分之一具有血流动力学意义的主髂动脉病变。本研究的目的是通过双功扫描改进对主髂动脉病变血流动力学意义的评估。
对60例患者进行了一项前瞻性研究，将静息状态下的双功扫描与注射罂粟碱前后的动脉内压力测量结果进行比较。使用简化的伯努利方程计算狭窄处的压力梯度（δPBern）。还测量了两个与血流相关的参数，即狭窄处收缩期峰值速度的增加（δPSV）和狭窄部位的舒张末期速度，并与动脉内压力测量结果进行比较。
δPBern和δPSV在静息状态下检测具有血流动力学意义病变的敏感性和特异性分别为81%和88%。然而，δPBern常常无法准确计算压力梯度。受试者工作特征分析表明，δPSV在1.4至1.5m/s范围内的截断水平最能检测静息状态下的显著病变。舒张末期速度参数的诊断价值有限。
尽管δPBern在临床决策中有用，但常常无法准确计算压力梯度。δPSV是区分显著和不显著狭窄的简单实用的频谱分析参数。如果在血流增加的条件下进行双功扫描，该参数还有检测血流动力学不太严重病变的潜力。需要进一步评估。
