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双功能超声对下肢动脉旁路移植术后再狭窄评估的临床应用

张华1,潘仲杰2,刘洪2,赵奇2,栗力3   

  1. 1. 天津市人民医院超声科
    2. 天津市人民医院血管科
    3. 天津市人民医院
  • 收稿日期:2014-01-14 修回日期:2014-03-18 出版日期:2014-07-15 发布日期:2014-07-15
  • 通讯作者: 张华

The Clinical Application of Duplex Ultrasonography in Evaluating the Restenosis of Peripheral Arterial Bypass Graft Postoperatively

  • Received:2014-01-14 Revised:2014-03-18 Published:2014-07-15 Online:2014-07-15
  • Contact: Hua ZHANG

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摘要：

【摘要】目的 探讨双功能超声（duplex US）对下肢动脉旁路移植术后再狭窄评估的临床价值。方法对我院 63例股腘动脉旁路移植患者的80条移植血管术后行duplex US定期随访，结合管径及血流动力学参数改变进行术后再狭窄判定，分为非显著狭窄组(56条)、显著狭窄组(15条)和闭塞组(9条)，并将duplex US诊断结果与金标准数字减影血管造影(DSA)对比分析；以移植血管中段峰值流速（MG）40cm/s为界值对移植血管闭塞风险进行评估。结果Du? plex US对移植血管狭窄程度分级的诊断与DSA的符合率达90%；duplex US诊断移植血管狭窄的灵敏度为91.7%，特异度为92.9%，阳性预测值为84.6%，阴性预测值为96.3%，假阳性率为16.7%，假阴性率为8.3%；移植血管MG＜40 cm/s组的移植血管闭塞率（62.5%）高于≥40cm/s组（5.4%）。结论Duplex US与DSA对下肢动脉旁路移植术后再狭窄的诊断有较好的一致性，且duplex US具有无创、简便，患者易于接受的特点。

关键词: 多普勒超声, 下肢动脉旁路移植术, 人工血管

Abstract:

[Abstract] Objective To explore the clinical value of the duplex ultrasonography (duplex US) for evaluating the re? stenosis after peripheral arterial bypass grafting.Methods Eighty prosthetic grafts of sixty-three patients with femoral-pop? liteal arterial bypass grafting were follow-up regularly by duplex US. They were divided into non significant stenosis group (n=56), the significant stenosis group (n=15) and occlusion group (n=9) according to the tube diameter and arterial blood flow? ing parameters, which changed postoperatively. The diagnostic results were compared and analyzed between duplex US and digital subtraction angiography (DSA). The peak flow velocity of middle grafts (MG) to40cm/s was defined to evaluate risk of graft occlusion.Results The diagnostic coincidence rate of duplex US and DSA for grafts stenosis classification was 90%. The diagnostic sensitivity of duplex US to grafts stenosis was91.7%, and the specificity was92.9%. The positive pre? dictive value was84.6% for grafts stenosis, and the negative predictive value was96.3%, the false positive rate was16.7%, and the false negative rate was8.3%. The grafts occlusion rate was higher in MG＜40cm/s group than that of MG≥40cm/s group.Conclusion There was a good consistency with Duplex US and DSA for the diagnosis of peripheral artery bypass graft restenosis. Duplex US showed characteristics of non-invasive, simple and easily accepted by patients.

Key words: duplex ultrasonography, peripheral arterial bypass grafting, prosthetic graft