Keen R R, Yao J S, Astleford P, Blackburn D, Frazin L J
Department of Surgery, Northwestern University Medical School, Chicago, IL, USA.
J Vasc Surg. 1996 Nov;24(5):834-42. doi: 10.1016/s0741-5214(96)70020-4.
Transesophageal echocardiography provides detailed images of the thoracic aorta, but imaging of the abdominal aorta and its branches does not occur routinely when the transesophageal echocardiography transducer is advanced into the stomach. Transgastric aortic ultrasonography (TAUS) was investigated as an intraoperative procedure to determine whether transgastric imaging of the abdominal aortic, mesenteric, and renal arteries could be obtained and whether pathologic lesions of these arteries could be identified.
Twelve patients with diagnoses of aortic aneurysmal or occlusive disease, chronic mesenteric ischemia, or renal artery stenosis that required operative treatment were examined. Preoperative transabdominal duplex imaging was performed in all 12 patients. Transgastric B-mode and color-flow ultrasonography of the abdominal aorta and branches was performed as an intraoperative procedure with the patients under general anesthesia. After the abdomen was opened but before the vascular reconstruction was performed, the transesophageal transducer was advanced into the stomach and directed by the surgeon's hand to obtain an image of the underlying aorta and branches. TAUS images were compared with those obtained by standard transabdominal duplex imaging.
TAUS provided high-resolution images of both aneurysmal and occlusive aortic disease. In all 12 cases the images of the aortic lumen, plaque, and thrombus obtained with TAUS had greater detail and better resolution than those obtained with transabdominal duplex imaging. The origins of the renal arteries were seen with TAUS in 23 of 24 cases, whereas transabdominal ultrasonography obtained images of the origins in only 6 of 24 cases (p < 0.01). In the five renal arteries and the one mesenteric artery with hemodynamically significant stenoses in which transabdominal ultrasonography identified the stenoses based on velocity criteria alone, TAUS visualized the occlusive plaque at the origin of the renal and mesenteric arteries.
Intraoperative TAUS is feasible and may be useful for evaluating atherosclerotic disease of the abdominal aorta and renal arteries.
经食管超声心动图可提供胸主动脉的详细图像，但当经食管超声心动图探头进入胃内时，腹主动脉及其分支的成像并非常规操作。经胃主动脉超声检查（TAUS）作为一种术中检查方法，旨在确定能否获得腹主动脉、肠系膜动脉和肾动脉的经胃成像，以及能否识别这些动脉的病理性病变。
对12例诊断为主动脉瘤或闭塞性疾病、慢性肠系膜缺血或肾动脉狭窄且需要手术治疗的患者进行检查。所有12例患者均进行了术前经腹双功超声成像。在全身麻醉下，对患者进行术中经胃B型和彩色血流超声检查腹主动脉及其分支。在打开腹腔但尚未进行血管重建之前，将经食管探头推进胃内，并由外科医生手动引导以获取下方主动脉及其分支的图像。将TAUS图像与标准经腹双功超声成像获得的图像进行比较。
TAUS提供了动脉瘤性和闭塞性主动脉疾病的高分辨率图像。在所有12例病例中，TAUS获得的主动脉管腔、斑块和血栓图像比经腹双功超声成像获得的图像细节更丰富、分辨率更高。24例中有23例通过TAUS看到了肾动脉的起源，而经腹超声检查仅在24例中的6例获得了起源处的图像（p < 0.01）。在5条肾动脉和1条肠系膜动脉存在血流动力学显著狭窄的情况下，经腹超声检查仅根据速度标准识别出狭窄，而TAUS则显示了肾动脉和肠系膜动脉起源处的闭塞性斑块。
术中TAUS是可行的，可能有助于评估腹主动脉和肾动脉的动脉粥样硬化疾病。
