Document Detail


Simple hyperaemia test as a screening method in the postoperative surveillance of infrainguinal in situ vein bypasses.
MedLine Citation:
PMID:  7552528     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To develop a simple protocol for ultrasound Duplex surveillance of infrainguinal vein bypasses. DESIGN: The value of three Doppler waveform parameters, obtained from a single point of the bypass, for identification of stenoses was studied in 91 in situ vein bypasses. Midgraft peak systolic velocity (PSV), pulsatility index (PI) and ratio of hyperaemic and resting time-average mean velocities (TAMV), (TAMV ratio = TAMVhyperaemia/TAMVrest) were correlated with the presence and severity of stenoses as assessed by conventional Duplex scanning and ankle-brachial index (ABI) measurements. The optimal value of the waveform parameters for discrimination between bypasses with and without evidence of stenoses was determined by receiver operating characteristics (ROC) analysis. MAIN RESULTS: Complete Duplex scanning of the entire graft revealed an increase in the peak systolic velocity by a factor 2.5 indicative of significant stenoses in 24 (26%) patients. A PSV below 55 cm/s was a poor indicator of stenoses (sensitivity 46%, specificity 76%) and PI < or = 3.8 only allowed suboptimal discrimination between normal and stenotic bypasses (sensitivity 63%, specificity 75%). The hyperaemic response assessed by TAMV ratio proved the best parameter for identification of graft stenoses. A TAMV ratio of 2.0 or less correctly identified 21 of the 24 lesions (sensitivity 88%, specificity 75%) and none of the three bypasses with evidence of stenoses and TAMV ratios exceeding 2.0 failed during follow-up. CONCLUSIONS: Single point waveform analysis of vein bypass velocity profile at rest and during reactive hyperaemia is a simple screening method providing diagnostic and prognostic information which may be of value in the postoperative surveillance of infrainguinal vein bypasses.
Authors:
T G Nielsen; H Sillesen; T V Schroeder
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  10     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  1995 Oct 
Date Detail:
Created Date:  1995-11-02     Completed Date:  1995-11-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  298-303     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery RK, Rigshospitalet, University of Copenhagen, Denmark.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Blood Flow Velocity
Constriction, Pathologic / physiopathology,  ultrasonography
Female
Follow-Up Studies
Graft Occlusion, Vascular / physiopathology,  ultrasonography*
Groin
Humans
Hyperemia / physiopathology,  ultrasonography*
Leg / blood supply*,  ultrasonography
Male
Middle Aged
Popliteal Artery / surgery
ROC Curve
Saphenous Vein / transplantation
Sensitivity and Specificity
Statistics, Nonparametric
Ultrasonography, Doppler, Duplex / instrumentation,  methods,  statistics & numerical data

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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