Hoballah J J, Nazzal M M, Ryan S M, Martinasevic M, Jacobovicz C, Rossley N, Blecha B, Sharp W J, Kresowik T F, Corson J D
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1086, USA.
Am J Surg. 1997 Aug;174(2):131-5. doi: 10.1016/s0002-9610(97)90070-2.
Unlike vein bypasses, the role of duplex surveillance of infrainguinal prosthetic bypass grafts is controversial. The purpose of this study was to evaluate the adequacy of color duplex surveillance in identifying failing infrainguinal polytetrafluoroethylene (PTFE) bypass grafts and to assess its value in predicting continued bypass patency.
The surveillance data of primarily patent PTFE bypass grafts were compared with those of revised/occluded PTFE grafts. Ninety-five patients underwent 102 infrainguinal PTFE bypass grafts from January 1991 to December 1996 and were enrolled in a duplex surveillance program at 1 month postoperatively, every 3 months in the first year, every 6 months in the second year, and yearly thereafter.
Seventy grafts remained primarily patent, 5 were revised and 27 occluded. There was no significant difference in the mean age, gender, indication for surgery, type of original procedure, or duration of follow-up between both groups. Four hundred and seven duplex surveillance data were available for analysis. Focal increase in peak systolic velocity (PSV) 3 x the adjacent segment or low flow manifested by PSV <45 cm/sec were considered abnormal. In the primarily patent group, 5 bypasses had abnormal duplex surveillance and were found to have no abnormality on angiogram and remained patent during the study period. In the revised/occluded group, duplex surveillance was abnormal in 8 bypasses. Twenty-four bypasses occluded without any predicting abnormalities on their last duplex examination, which was performed within 3 months from the occlusion in the majority of the patients. In the 27 occluded bypasses, no intervention was necessary following the occlusion in 7 grafts because of mild or no symptoms. Two patients were treated with a primary amputation and 2 had new bypasses. In 16 occluded grafts, salvage of the PTFE bypass was attempted. Ten of these grafts were patent at the end of the follow-up. The sensitivity of duplex surveillance was 25% with a positive predictive value of 61.5%.
Duplex surveillance of infrainguinal PTFE bypass grafts has a low yield and is inadequate at predicting continued bypass patency.
与静脉搭桥不同，腹股沟下人工血管搭桥的双功超声监测作用存在争议。本研究的目的是评估彩色双功超声监测在识别腹股沟下聚四氟乙烯（PTFE）搭桥血管功能障碍方面的充分性，并评估其在预测搭桥血管持续通畅方面的价值。
将原发性通畅的PTFE搭桥血管的监测数据与修订/闭塞的PTFE血管的数据进行比较。1991年1月至1996年12月，95例患者接受了102例腹股沟下PTFE搭桥手术，并在术后1个月、第一年每3个月、第二年每6个月以及此后每年纳入双功超声监测项目。
70条血管仍保持原发性通畅，5条进行了修订，27条闭塞。两组在平均年龄、性别、手术指征、原手术类型或随访时间方面无显著差异。有407份双功超声监测数据可供分析。收缩期峰值流速（PSV）较相邻节段增加3倍或PSV<45 cm/秒所显示的低血流被视为异常。在原发性通畅组中，5条搭桥血管双功超声监测异常，但血管造影未发现异常，且在研究期间保持通畅。在修订/闭塞组中，8条搭桥血管双功超声监测异常。24条搭桥血管在最后一次双功超声检查时无任何预测异常，但随后闭塞，大多数患者的最后一次双功超声检查在闭塞前3个月内进行。在27条闭塞的搭桥血管中，7条血管闭塞后因症状轻微或无症状而无需干预。2例患者接受了一期截肢，2例进行了新的搭桥手术。在16条闭塞的血管中，尝试挽救PTFE搭桥血管。其中10条血管在随访结束时保持通畅。双功超声监测的敏感性为25%，阳性预测值为61.5%。
腹股沟下PTFE搭桥血管的双功超声监测阳性率较低，在预测搭桥血管持续通畅方面不足。
