Ligush J, Reavis S W, Preisser J S, Hansen K J
Division of Surgical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
J Vasc Surg. 1998 Sep;28(3):482-90; discussion 490-1. doi: 10.1016/s0741-5214(98)70134-x.
To characterize the accuracy of color-flow duplex ultrasound (DUS) in planning lower extremity revascularization procedures, we prospectively compared operations predicted by means of DUS arterial scanning (DUSAS) and operations predicted by means of conventional angiography (CA) with actual operations performed in 36 patients undergoing 40 vascular reconstructions for critical (grade II/III) lower extremity ischemia.
All patients were examined with lower extremity DUSAS followed by CA. DUSAS was performed from the aorta to the pedal vessels of the affected extremity. Adequacy of inflow was assessed, and the best distal target vessel with continuous, unobstructed flow was defined. An operative prediction was made and recorded based upon the DUSAS findings, and in a blinded fashion, based upon subsequent CA. The McNemar test for comparing correlated proportions was applied to test for the statistical significance of the difference (P < .05) between correct operations predicted by DUSAS and CA.
Of the actual operations performed, 83% were correctly predicted by means of DUSAS (95% CI; range, 77% to 89%). Seven operations were incorrectly predicted with DUSAS. Of the actual operations performed, 90% were correctly predicted by means of CA (95% CI; range, 81% to 99%). Four operations were incorrectly predicted with CA. The McNemar test determined that the difference between correct operations predicted by means of DUSAS and correct operations predicted by means of CA was not statistically significant (P = .50).
With few exceptions, DUSAS can be used to reliably predict infrainguinal reconstruction strategies. Vessels defined as adequate with DUSAS are rarely unfit for bypass. Prospective investigation of lower extremity revascularization based solely upon DUSAS is warranted.
为了明确彩色血流双功超声（DUS）在规划下肢血管重建手术中的准确性，我们前瞻性地比较了通过DUS动脉扫描（DUSAS）预测的手术、通过传统血管造影（CA）预测的手术与36例因严重（II/III级）下肢缺血接受40次血管重建手术的患者实际进行的手术。
所有患者均先接受下肢DUSAS检查，随后进行CA检查。DUSAS检查从主动脉至患侧下肢的足部血管。评估流入道是否充足，并确定具有连续、通畅血流的最佳远端目标血管。根据DUSAS检查结果做出并记录手术预测，并且在不知情的情况下，根据后续的CA检查做出手术预测。应用用于比较相关比例的McNemar检验来检验DUSAS和CA预测的正确手术之间差异的统计学显著性（P < 0.05）。
在实际进行的手术中，83%可通过DUSAS正确预测（95%置信区间；范围，77%至89%）。DUSAS错误预测了7例手术。在实际进行的手术中，90%可通过CA正确预测（95%置信区间；范围，81%至99%）。CA错误预测了4例手术。McNemar检验确定，通过DUSAS预测的正确手术与通过CA预测的正确手术之间的差异无统计学显著性（P = 0.50）。
除少数例外情况外，DUSAS可用于可靠地预测腹股沟下重建策略。被DUSAS定义为充足的血管很少不适合进行旁路手术。仅基于DUSAS对下肢血管重建进行前瞻性研究是有必要的。
