Follow-up of valves in saphenous vein bypass grafts with duplex ultrasonography.
Follow-up of valves in saphenous vein bypass grafts with duplex ultrasonography.
复制标题
通过双超声检查对隐静脉旁路移植物中的瓣膜进行随访。
DOI：
10.1067/mva.2001.111744
复制
发表时间：
2001
影响因子：
4.3
通讯作者：
StrandnessJr,E
中科院分区：
文献类型：
--
作者：
Vesti,BR;Primozich,J;Bergelin,RO;StrandnessJr,E
目的本研究的目的是通过双超声检查描述静脉瓣膜并确定其在逆行隐静脉 (RSV) 和原位隐静脉 (ISV) 旁路移植物中随时间的变化。方法 64 名患者贡献了 50 个 RSV 和 19 个 ISV 腹股沟下静脉移植物。 42 个 RSV 和 17 个 ISV 具有瓣膜或瓣膜残余物。使用双功超声检查对移植物和瓣膜进行连续研究，以记录位置、特征和随时间的变化。通过超声双工扫描可视化的瓣膜小叶被描述为移动的、冻结的、尖瓣的残余物或“功能正常”。此外，记录了瓣膜窦的存在和该部位壁的增厚。在第 1、2、3、4、6、9、12 和 18 个月时对移植物进行研究，然后每年进行一次。结果 在 42 个 RSV 移植物 (84%) 和 17 个 ISV 移植物 (89.5%) 中，鉴定出 200 个瓣膜。由于速度比 (VR) 为 3.5 或更大，200 个阀门中只有 5 个 (2.5%) 需要干预。 19 例 ISV 移植物中的 8 例 (42.1%) 需要 15 次修订，50 例 RSV 移植物中的 18 例 (36%) 需要 30 次修订。狭窄瓣膜的五次修复仅发生在 RSV 移植物中。在 RSV 移植物的 30 次修复中，只有 16.7%（30 次中有 5 次）是针对与瓣膜相关的狭窄。从检测到阀门的平均随访时间为 16.1 ± 9.6 个月。 17 例 (58.8%) 瓣膜相关狭窄 (VR > 2.5) 中的 10 例在平均 3.1 个月（范围 1.5-4.5 个月）内显示出 VR 小于 2.0 的回归。在3.5个月的时间内，瓣膜相关病变从VR小于2.0进展到VR高于3.5，仅发生在1例中。结论所描述的大隐静脉移植物中瓣膜的特征是常见的，并且可以通过双重超声检查来识别。只有 16.7% 的 RSV 移植物翻修是由于瓣膜相关狭窄而进行的，而 ISV 移植物中没有任何翻修是因为瓣膜病变而进行的。与瓣膜相关的病变可能会及时消退。没有特定的瓣膜特征可以被识别为移植失败的“高”风险。 (J Vasc Surg 2001；33:369-74。)
PurposeThe objectives of this study were to describe the venous valves and determine their fate over time in reversed saphenous vein (RSV) and in situ saphenous vein (ISV) bypass grafts with duplex ultrasonography.MethodsSixty-four patients contributed 50 RSV and 19 ISV infrainguinal vein grafts. Forty-two of the RSVs and 17 of the ISVs had valves or valve remnants. The grafts and valves were studied serially with duplex ultrasonography to document the location, characteristics, and changes with time. The valve leaflets visualized by means of ultrasonic duplex scanning were described as moving, frozen, remnant of a cusp, or “functioning.” In addition, the presence of a valve sinus and thickening of the wall at the site were documented. Grafts were studied at 1, 2, 3, 4, 6, 9, 12, and 18 months and then annually.ResultsIn 42 RSV grafts (84%) and 17 ISV grafts (89.5%), 200 valves were identified. Only five of the 200 valves (2.5%) required intervention because of a velocity ratio (VR) of 3.5 or greater. Eight (42.1%) of the 19 ISV grafts needed 15 revisions, and 18 (36%) of the 50 RSV grafts required 30 revisions. The five revisions for a stenotic valve occurred only in RSV grafts. From the 30 revisions in the RSV grafts, only 16.7% (5 of 30) were for a valve-related stenosis. The average follow-up period for a valve from the time of detection was 16.1 ± 9.6 months. Ten of the 17 (58.8%) valve-associated stenoses (VR > 2.5) showed a regression to a VR less than 2.0 within a mean time of 3.1 months (range, 1.5-4.5 months). A progression of the valve-associated lesion from a VR less than 2.0 to a VR higher than 3.5 occurred in only one case within a period of 3.5 months.ConclusionThe described features of valves in saphenous vein grafts are common and can be identified by means of duplex sonography. Only 16.7% of the revisions in RSV grafts were performed because of a valve-related stenosis, and none of the revisions in ISV grafts were performed because of a valve lesion. Lesions associated with a valve may regress in time. No specific valve features could be identified as “high” risk for graft failure. (J Vasc Surg 2001;33:369-74.)