The use of duplex ultrasound arterial mapping as an alternative to conventional arteriography for primary and secondary infrapopliteal bypasses

被引:64
作者
Ascher, E [1 ]
Mazzariol, F [1 ]
Hingorani, A [1 ]
Salles-Cunha, S [1 ]
Gade, P [1 ]
机构
[1] Maimonides Med Ctr, Dept Vasc Surg, Brooklyn, NY 11219 USA
关键词
D O I
10.1016/S0002-9610(99)00151-8
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: For more than 1 decade, duplex ultrasonography has been investigated as a potential replacement for invasive contrast arteriography (CA) prior to Tower extremity revascularization. While some authors advocate the reliability of this methodology for infrainguinal imaging, revascularizations based on duplex ultrasonography alone are seldom reported. Our initial experience with duplex ultrasound arterial mapping (DUAM) for primary and secondary infrapopliteal bypasses performed without preoperative CA is reported in this series. METHODS: Twenty-eight infrapopliteal bypasses based on DUAM alone (26) and combined DUAM and CA (2) were performed. Indications for surgery were tissue loss in 22 cases and rest pain in 6. Eight patients (29%) had at least 1 previous ipsilateral revascularization. A schematic anatomical drawing based on DUAM helped the selection of optimal inflow and outflow bypass sites. Bypasses originated from the femoral arteries in 17 cases, external iliac in 3, and popliteal in 4, and from a previous graft in 4. The distal anastomosis was to the dorsalis pedis in 12 cases, posterior tibial in 7, anterior tibial in 6, and peroneal in 3. RESULTS: DUAM revealed unobstructed inflow in 24 cases, significant iliac stenosis in 1, and in 3 cases imaging was not possible owing to obesity. A pressure gradient of 15 mm Hg between donor and radial artery confirmed the stenosis diagnosed by DUAM, and was successfully treated with balloon angioplasty and stent placement. A single infrapopliteal runoff artery was identified by DUAM in 22 cases, 2 in 4 cases, and 3 in 2 cases. Preoperative CA was performed in 2 instances because of severe arterial calcification. Completion arteriography matched the run-off status predicted by DUAM in 25 out of 26 cases (96%). DUAM missed a significant anterior tibial artery stenosis that required a distal graft extension. One-, 3-, and 6-month patency rates were 96%, 85%, and 62%, respectively. Limb salvage rate was 86%. CONCLUSIONS: This early experience shows that DUAM may be a safe alternative to invasive conventional arteriography for the majority of patients (89%) presenting with critical ischemia and in need of infrapopliteal bypasses. Am J Surg. 1999;178:162-165. (C) 1999 by Excerpta Medica, Inc.
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页码:162 / 165
页数:4
相关论文
共 12 条
[1]   IMPACT OF ULTRASONOGRAPHIC DUPLEX SCANNING ON THERAPEUTIC DECISION-MAKING IN LOWER-LIMB ARTERIAL-DISEASE [J].
ELSMAN, BHP ;
LEGEMATE, DA ;
VANDERHEIJDEN, FHWM ;
DEVOS, HJ ;
MALI, WPTM ;
EIKELBOOM, BC .
BRITISH JOURNAL OF SURGERY, 1995, 82 (05) :630-633
[2]   Value of duplex scanning in evaluation of crural and foot arteries in limbs with severe lower limb ischaemia - A prospective comparison with angiography [J].
Karacagil, S ;
Lofberg, AM ;
Granbo, A ;
Lorelius, LE ;
Bergquist, D .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 1996, 12 (03) :300-303
[3]  
Lai D T, 1996, Cardiovasc Surg, V4, P384, DOI 10.1016/0967-2109(95)00064-X
[4]   Value of color duplex sonography for evaluation of tibioperoneal arteries in patients with femoropopliteal obstruction: A prospective comparison with anterograde intraarterial digital subtraction angiography [J].
Larch, E ;
Minar, E ;
Ahmadi, R ;
Schnurer, G ;
Schneider, B ;
Stumpflen, A ;
Ehringer, H .
JOURNAL OF VASCULAR SURGERY, 1997, 25 (04) :629-636
[5]  
Legemate D A, 1989, Eur J Vasc Surg, V3, P49, DOI 10.1016/S0950-821X(89)80108-2
[6]   Values and limitations of duplex ultrasonography as the sole imaging method of preoperative evaluation for popliteal and infrapopliteal bypasses [J].
Mazzariol, F ;
Ascher, E ;
Salles-Cunha, SX ;
Gade, P ;
Hingorani, A .
ANNALS OF VASCULAR SURGERY, 1999, 13 (01) :1-10
[7]   ACCURACY OF LOWER-EXTREMITY ARTERIAL DUPLEX MAPPING [J].
MONETA, GL ;
YEAGER, RA ;
ANTONOVIC, R ;
HALL, LD ;
CASTER, JD ;
CUMMINGS, CA ;
PORTER, JM .
JOURNAL OF VASCULAR SURGERY, 1992, 15 (02) :275-284
[8]   Can lower limb vascular reconstruction be based on colour duplex imaging alone? [J].
Pemberton, M ;
Nydahl, S ;
Hartshorne, T ;
Naylor, AR ;
Bell, PRF ;
London, NJM .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 1996, 12 (04) :452-454
[9]  
SALLESCUNHA SX, 1990, SURG CLIN N AM, V70, P41
[10]   Is routine preoperative aortoiliac arteriography necessary in the treatment of lower extremity ischemia? [J].
Schneider, PA ;
Ogawa, DY .
JOURNAL OF VASCULAR SURGERY, 1998, 28 (01) :28-36