Gaunt M E, Smith J L, Ratliff D A, Bell P R, Naylor A R
Department of Surgery, Leicester Royal Infirmary, U.K.
Eur J Vasc Endovasc Surg. 1996 Jan;11(1):4-11. doi: 10.1016/s1078-5884(96)80128-6.
To compare the ability of continuous wave Doppler (CWD), B-mode ultrasound (BMU), angioscopy and transcranial Doppler (TCD) to detect technical error during carotid endarterectomy (CEA).
A prospective, comparative study in 100 consecutive patients.
Leicester Royal Infirmary, Leicester, U.K.
Intraoperative TCD monitoring was performed using a SciMed PcDop 842 2 MHz TCD. An Olympus 2.8mm flexible angioscope was used to inspect the arterial lumen prior to restoration of bloodflow. After restoration of flow 10Mhz BMU images and 8Mhz CWD velocity spectra of carotid artery blood flow were obtained.
The detection of intimal flaps, thrombus, stenoses or other errors of surgical technique likely to result in perioperative morbidity.
CWD and BMU images were technically inadequate in 9% and 24% of cases respectively and neither technique altered clinical management. Angioscopy demonstrated significant technical errors in 12 cases (four intimal flaps, thrombus in eight). TCD detected shunt malfunction in 13% of patients, emboli during dissection in 23% and early postoperative carotid artery thrombosis in three patients.
A combination of TCD monitoring and completion angioscopy provided the maximum yield in terms of diagnosing technical error and establishing the cause of perioperative morbidity.
比较连续波多普勒（CWD）、B 型超声（BMU）、血管镜检查和经颅多普勒（TCD）在颈动脉内膜切除术（CEA）期间检测技术失误的能力。
对 100 例连续患者进行的前瞻性比较研究。
英国莱斯特皇家医院
术中使用 SciMed PcDop 842 2MHz TCD 进行 TCD 监测。在恢复血流之前，使用奥林巴斯 2.8mm 柔性血管镜检查动脉管腔。恢复血流后，获取颈动脉血流的 10MHz BMU 图像和 8MHz CWD 速度频谱。
检测内膜瓣、血栓、狭窄或其他可能导致围手术期发病的手术技术失误。
CWD 和 BMU 图像在技术上分别有 9%和 24%的病例不充分，且两种技术均未改变临床管理。血管镜检查在 12 例中显示出明显的技术失误（4 例内膜瓣，8 例血栓）。TCD 在 13%的患者中检测到分流故障，在 23%的患者中检测到解剖期间的栓子，在 3 例患者中检测到术后早期颈动脉血栓形成。
TCD 监测和完成血管镜检查相结合，在诊断技术失误和确定围手术期发病原因方面提供了最大的收获。
