Jackson M R, D'Addio V J, Gillespie D L, O'Donnell S D
Vascular Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Am J Surg. 1996 Aug;172(2):184-7. doi: 10.1016/S0002-9610(96)00148-1.
The purpose of this study is to evaluate the results of color-flow duplex ultrasound (CFD) soon after carotid endarterectomy (CEA) to determine the incidence of residual abnormalities and their effect on subsequent outcome and management.
We reviewed 318 consecutive CEAs performed over a 48 month-period. Of these, 206 were followed up with CFD, 195 prior to discharge and 11 at first follow-up (within 9 weeks). Patients (43) followed up with only oculoplethysmography (OPG) or those with no OPG or CFD (69) were excluded from the study. All CEAs were performed under general anesthesia with routine shunting and patch angioplasty.
Twelve of the 206 studies (5.8%) were abnormal. Two patients with an abnormal CFD sustained perioperative stroke, both of whom had distal intimal lesions of > 60% diameter stenosis by velocity criteria. Four patients had > 60% stenosis and were reoperated upon to correct technical errors. The remaining 6 patients are asymptomatic. Four had residual lesions of < 60% stenosis, three of which have returned to normal on subsequent CFD. Two residual lesions had > 60% stenosis; one returned to normal by CFD and the other remains abnormal at 10 months. In the group of 192 normal postoperative CFD studies, there were no strokes, deaths, or redo procedures (0%, 95% confidence interval 0% to 1.54%) compared with a combined 50% rate (6 of 12) of either stroke (2 of 12) or redo procedure (4 of 12) when the postoperative CFD was abnormal (95% confidence interval 22.3% to 77.7%, P < 0.0001). During the study period the CEA stroke rate was 0.9% (3 of 318), with a combined stroke-mortality rate of 1.3% (4 of 318).
Early postoperative CFD identified residual abnormalities in 5.8% of carotid endarterectomies despite a low overall stroke mortality rate. One half of these abnormalities resulted in stroke or required operative correction. Colorflow duplex ultrasound is useful in identifying residual abnormalities following CEA and should be considered for intraoperative use.
本研究的目的是评估颈动脉内膜剥脱术（CEA）后不久彩色血流双功超声（CFD）的结果，以确定残余异常的发生率及其对后续结果和处理的影响。
我们回顾了在48个月期间连续进行的318例CEA。其中，206例接受了CFD随访，195例在出院前，11例在首次随访时（9周内）。仅接受眼体积描记法（OPG）随访的患者（43例）或未进行OPG或CFD检查的患者（69例）被排除在研究之外。所有CEA均在全身麻醉下进行，常规使用分流术和补片血管成形术。
206例研究中有12例（5.8%）异常。2例CFD异常的患者发生围手术期卒中，二者均根据速度标准存在直径狭窄>60%的远端内膜病变。4例患者狭窄>60%，接受再次手术以纠正技术错误。其余6例患者无症状。4例有残余病变，狭窄<60%，其中3例在随后的CFD检查中恢复正常。2例残余病变狭窄>60%；1例通过CFD检查恢复正常，另1例在10个月时仍异常。在192例术后CFD检查正常的患者组中，无卒中、死亡或再次手术情况（0%，95%置信区间为0%至1.54%），而术后CFD异常时，卒中（12例中的2例）或再次手术（12例中的4例）的合并发生率为50%（12例中的6例）（95%置信区间为22.3%至77.7%，P<0.0001）。在研究期间，CEA的卒中发生率为0.9%（318例中的3例），卒中死亡率合并率为1.3%（318例中的4例）。
尽管总体卒中死亡率较低，但术后早期CFD在5.8%的颈动脉内膜剥脱术中发现了残余异常。这些异常中有一半导致了卒中或需要手术矫正。彩色血流双功超声有助于识别CEA后的残余异常，应考虑在术中使用。
