Detection of ''functional'' valves in reversed saphenous vein bypass grafts: Identification with duplex ultrasonography
Detection of ''functional'' valves in reversed saphenous vein bypass grafts: Identification with duplex ultrasonography
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DOI：
10.1016/s0741-5214(97)70263-5
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发表时间：
1997-03-01
影响因子：
4.3
通讯作者：
Strandness, DE
中科院分区：
文献类型：
--
作者：
Tullis, MJ;Primozich, J;Strandness, DE
目的：尽管静脉瓣膜损伤被认为是移植物失败的一种机制，但静脉瓣膜在逆行大隐静脉(RSV)搭桥术中的命运尚不清楚。这种不确定性的基础是术后识别和随访瓣膜部位的困难，以及静脉移植物病变的罕见病理表现。本文描述了超声双功扫描显示的RSV移植物的“功能性”瓣膜(FV)的特征。方法：对1992年1月至1995年12月应用双功超声对66例RSV腹股沟下静脉移植物进行前瞻性研究。分别于术后1、2、3、4、6、9、12、18和24个月对移植物进行研究，然后每年进行。FV的识别是基于特征的超声多普勒波形和彩色血流模式，并通过B型超声成像显示叶。波形包括收缩末期瓣膜关闭，然后是不同程度的返流。术后即刻反应性充血不能被发现，因为需要移植物内的血流逆转来识别。结果：自1994年8月以来，在66例RSV移植物中，11例(17%)检出了14例FV。植入后FV识别时间1~52个月，平均10个月，平均随访15个月。有一个阀门是完全合格的。7个(50%)的FV与一种
Purpose: Although venous valve lesions have been cited as a mechanism of graft failure, the fate of venous valves in reversed saphenous vein (RSV) bypass grafts is unclear. The basis for this uncertainty is the difficulty in postoperative identification and follow-up of valve sites and the infrequent pathologic submission of vein graft lesions. This report describes the features of ''functional'' valves (FV) visualized in RSV grafts by ultrasonic duplex scanning.Methods: Sixty-six RSV infrainguinal vein grafts were prospectively studied with duplex ultrasonography from January 1992 to December 1995. Grafts were studied at 1, 2, 3, 4, 6, 9, 12, 18, and 24 months, then annually. FV identification was based on a characteristic ultrasound Doppler waveform and color flow pattern and visualization of the leaflets by B-mode imaging. The waveform consists of end-systolic valve closure followed by variable degrees of reflux. Immediate postoperative reactive hyperemia precludes detection, because flow reversal in the graft is needed for identification.Results: Since August 1994, 14 FV have been identified in 11 (17%) of 66 RSV grafts. The mean time to FV recognition after implantation was 10 months (range, 1 to 52 months), and the average follow-up was 15 months. One valve was completely competent. Seven (50%) of the FV were associated with the development of a