Intraoperative duplex scanning of arterial reconstructions: Fate of repaired and unrepaired defects

Dennis F. Bandyk, Joseph L Mills, Vivian Gahtan, Glenn E. Esses

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Purpose: Because unrecognized lesions can cause an arterial reconstruction to fail, duplex ultrasonography was evaluated as an intraoperative aid to assess technical adequacy and provide criteria for which lesions should be repaired immediately versus safely followed. Methods: Since 1990 intraoperative color duplex scanning (7 to 10 MHz linear array probe, pulsed-wave Doppler test spectrum analysis) was used to assess the frequency and severity of residual lesions in 368 patients after carotid endarterectomy (n = 210), infrainguinal vein bypass (n = 135), or visceral/renal reconstruction (n = 23). Duplex scan results were categorized as normal or abnormal, with immediate repair of lesions demonstrating both lumen reduction and severe focal flow abnormalities (peak systolic velocity [Vp] > 150 to 180 cm/sec; velocity ratio [Vr] > 2.4). Arteriography was also performed in 81% of lower limb bypass procedures. Results: Duplex scanning identified technical (residual plaque, stricture) or intrinsic defects (platelet thrombus, distal thrombosis) requiring revision in 37 (10%) of the reconstructions. Infrainguinal bypass had the highest incidence of corrected defects (14%) and adverse events (3%). No adverse events occurred in patients with normal duplex scan results or after carotid endarterectomy. Overall, 76% of identified defects were corrected (carotid, 17 of 24; infrainguinal bypass, 19 of 24; visceral bypass, 1 of 1). Unrepaired flow defects (Vp = 150 to 190 cm/sec; Vr = 1.8 to 2.5) led to one graft occlusion and three early revisions. Postoperative duplex scanning demonstrated residual stenosis in seven of 12 patients with unrepaired defects, two of 36 patients with repaired defects, and five of 312 patients with normal scan results (p < 0.001). Conclusion: Based on the types of lesions corrected and the low (< 0.5%) complication rate after a normal or modified arterial reconstruction, duplex scanning was found to be a valuable intraoperative aid. Unrepaired defects require close surveillance for progression.

Original languageEnglish (US)
Pages (from-to)426-433
Number of pages8
JournalJournal of Vascular Surgery
Volume20
Issue number3
DOIs
StatePublished - 1994
Externally publishedYes

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Carotid Endarterectomy
Pathologic Constriction
Thrombosis
Lower Extremity
Veins
Ultrasonography
Spectrum Analysis
Angiography
Blood Platelets
Color
Transplants
Kidney
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Intraoperative duplex scanning of arterial reconstructions : Fate of repaired and unrepaired defects. / Bandyk, Dennis F.; Mills, Joseph L; Gahtan, Vivian; Esses, Glenn E.

In: Journal of Vascular Surgery, Vol. 20, No. 3, 1994, p. 426-433.

Research output: Contribution to journalArticle

Bandyk, Dennis F. ; Mills, Joseph L ; Gahtan, Vivian ; Esses, Glenn E. / Intraoperative duplex scanning of arterial reconstructions : Fate of repaired and unrepaired defects. In: Journal of Vascular Surgery. 1994 ; Vol. 20, No. 3. pp. 426-433.
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abstract = "Purpose: Because unrecognized lesions can cause an arterial reconstruction to fail, duplex ultrasonography was evaluated as an intraoperative aid to assess technical adequacy and provide criteria for which lesions should be repaired immediately versus safely followed. Methods: Since 1990 intraoperative color duplex scanning (7 to 10 MHz linear array probe, pulsed-wave Doppler test spectrum analysis) was used to assess the frequency and severity of residual lesions in 368 patients after carotid endarterectomy (n = 210), infrainguinal vein bypass (n = 135), or visceral/renal reconstruction (n = 23). Duplex scan results were categorized as normal or abnormal, with immediate repair of lesions demonstrating both lumen reduction and severe focal flow abnormalities (peak systolic velocity [Vp] > 150 to 180 cm/sec; velocity ratio [Vr] > 2.4). Arteriography was also performed in 81{\%} of lower limb bypass procedures. Results: Duplex scanning identified technical (residual plaque, stricture) or intrinsic defects (platelet thrombus, distal thrombosis) requiring revision in 37 (10{\%}) of the reconstructions. Infrainguinal bypass had the highest incidence of corrected defects (14{\%}) and adverse events (3{\%}). No adverse events occurred in patients with normal duplex scan results or after carotid endarterectomy. Overall, 76{\%} of identified defects were corrected (carotid, 17 of 24; infrainguinal bypass, 19 of 24; visceral bypass, 1 of 1). Unrepaired flow defects (Vp = 150 to 190 cm/sec; Vr = 1.8 to 2.5) led to one graft occlusion and three early revisions. Postoperative duplex scanning demonstrated residual stenosis in seven of 12 patients with unrepaired defects, two of 36 patients with repaired defects, and five of 312 patients with normal scan results (p < 0.001). Conclusion: Based on the types of lesions corrected and the low (< 0.5{\%}) complication rate after a normal or modified arterial reconstruction, duplex scanning was found to be a valuable intraoperative aid. Unrepaired defects require close surveillance for progression.",
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