Intraoperative B-mode ultrasonography is a useful adjunct to peripheral arterial reconstruction.

We used an ultrasound imaging system with a 10 MHz probe during 118 vascular procedures. These procedures included 56 cerebrovascular, 38 infrainguinal, 16 renal, 4 mesenteric, and 4 aortic reconstructions. In 29 procedures, intraoperative ultrasonography was used to supplement or replace preoperative arteriography to better define the extent of disease for the optimal placement of an anastomosis or to determine the need for an additional reconstructive procedure. In 106 cases, ultrasonography was used for postreconstruction assessment. Of the 21 (20%) defects found, 11 (10%) were deemed important enough to warrant correction. Defects were significantly more common following endarterectomy procedures (p < 0.01). All 11 of the major defects were successfully repaired, and neither the corrected defects nor the 10 uncorrected minor defects were associated with postoperative complications. Patients (with and without defects) underwent routine early postoperative follow-up assessment of the technical adequacy of their reconstruction using color duplex imaging; no residual defects were discovered. Two (2%) postoperative occlusions (one femorofemoral and one aortorenal bypass) occurred without a technical defect noted on reexploration. This clinical experience demonstrates that B-mode ultrasonography can supplement or replace preoperative arteriography in selected cases and is a valuable technique for identifying defects intraoperatively so that they can be immediately corrected.