Tielbeek A V, Rietjens E, Buth J, Vroegindeweij D, Schol F P
Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
Eur J Vasc Endovasc Surg. 1996 Aug;12(2):145-50. doi: 10.1016/s1078-5884(96)80099-2.
The objective of the present study was to assess prospectively whether serial Duplex examination was useful in identifying impending failure after endovascular interventions of the femoropopliteal arteries.
Non-university hospital. Prospective clinical study.
124 Patients were successfully treated by endovascular procedures during a 5 year period. The follow-up was by colour-flow Duplex examination at fixed intervals. At similar intervals clinical examination, including ankle blood pressure measurement was performed to assess the clinical/haemodynamic status of the patients according to the SVS/NAISCVS guidelines. For the diagnosis of impending failure the Duplex criterion was a peak systolic velocity ratio > 2.5 and the clinical/haemodynamic criterion was a level < +2. Actual failure of the vascular procedure was defined as the occurrence of an occlusion in the treated arterial segment or a recurrent stenosis causing symptoms severe enough to require a reintervention. No prophylactic reinterventions were performed on the basis of abnormal Duplex findings alone.
Abnormal Duplex findings indicating restenosis were observed in 52 patients. Duplex abnormalities predicted treatment failure with a sensitivity of 86% and a specificity of 75%, while clinical/haemodynamic assessment had a sensitivity of 93% and a specificity of 90%. The hypothetical management outcome if Duplex surveillance had been used as a basis for reintervention was assessed. It appeared that only one patient with failure would have received a redo endovascular procedure at the time he had a restenosis.
Clinical/haemodynamic assessment was more useful for the follow-up of endovascular interventions than Duplex surveillance.
本研究的目的是前瞻性评估系列双功超声检查在识别股腘动脉血管腔内介入术后即将出现的失败情况方面是否有用。
非大学医院。前瞻性临床研究。
在5年期间，124例患者通过血管腔内手术成功治疗。通过定期进行彩色血流双功超声检查进行随访。按照类似的间隔进行临床检查，包括测量踝部血压，以根据SVS/NAISCVS指南评估患者的临床/血流动力学状态。对于即将出现失败的诊断，双功超声标准为收缩期峰值速度比>2.5，临床/血流动力学标准为水平<+2。血管手术的实际失败定义为治疗的动脉段出现闭塞或复发狭窄，导致症状严重到需要再次干预。不会仅基于双功超声检查结果异常就进行预防性再次干预。
52例患者观察到提示再狭窄的双功超声检查结果异常。双功超声异常预测治疗失败的敏感性为86%，特异性为75%，而临床/血流动力学评估的敏感性为93%，特异性为90%。评估了如果将双功超声监测用作再次干预的基础时假设的管理结果。似乎只有一名失败患者在出现再狭窄时会接受再次血管腔内手术。
临床/血流动力学评估在血管腔内介入术后的随访中比双功超声监测更有用。
