Monitoring Flow in Extracranial-Intracranial Bypass Grafts Using Duplex Ultrasonography: A Single-Center Experience in 80 Grafts Over 8 Years
Monitoring Flow in Extracranial-Intracranial Bypass Grafts Using Duplex Ultrasonography: A Single-Center Experience in 80 Grafts Over 8 Years
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DOI：
10.1227/neu.0000000000000198
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发表时间：
2014-01-01
期刊：
影响因子：
4.8
通讯作者：
Sekhar, Laligam N.
中科院分区：
文献类型：
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作者：
Morton, Ryan P.;Moore, Anne E.;Sekhar, Laligam N.
背景技术背景：高流量颅外-颅内（EC-IC）旁路是通过使用桡动脉造影（RAG）或隐静脉移植物（SVG）进行的，用于各种病理，如动脉瘤、缺血和颅底肿瘤。量化的可接受的血流量，以保持适当的脑灌注量尚未建立，也没有影响流量的变量被determined.OBJECTIVE：确定通过颅外-颅内RAGs和SVGs的血流的标准范围，通过双功超声测量。多个变量进行了评估，以更好地了解他们的影响，移植flow.METHODS：所有EC-IC移植在港景医疗中心从2005年至2012年进行了回顾性审查，本队列研究。每日进行颅外移植物双功超声检查和经颅移植物多普勒血流检查，以及短期和长期结果。缺血和充血事件进行了评估，在进一步details.Results：80个可监测的高流量EC-IC旁路在8年期间进行。65例采用RAGs进行旁路手术，15例采用SVGs进行旁路手术。RAG的平均流量为133 mL/min，SVG为160 mL/min（P = .25）。对于RAG和SVG组，供体和受体血管选择显著影响血流。仅对于RAG组，术前移植物直径、术后红细胞压积和术后日期显著影响血流。一个1周的平均值>200毫升/分钟是100%敏感脑充血syndrome.CONCLUSION：本研究建立了规范的范围后，高流量EC-IC旁路双功超声血流，以及有用性和实用性，这样的监测作为一个替代流量在术后期间。
BACKGROUND: High-flow extracranial-intracranial (EC-IC) bypass is performed by using radial artery graphs (RAGs) or saphenous vein grafts (SVGs) for various pathologies such as aneurysms, ischemia, and skull-base tumors. Quantifying the acceptable amount of blood flow to maintain proper cerebral perfusion has not been well established, nor have the variables that influence flow been determined.OBJECTIVE: To identify the normative range of blood flow through extracranial-intracranial RAGs and SVGs as measured by duplex ultrasonography. Multiple variables were evaluated to better understand their influence of graft flow.METHODS: All EC-IC grafts performed at Harborview Medical Center from 2005 to 2012 were retrospectively reviewed for this cohort study. Daily extracranial graft duplex ultrasonography with flow volumes and transcranial graft Doppler were examined, as were short-and long-term outcomes. Both ischemic and hyperemic events were evaluated in further detail.RESULTS: Eighty monitorable high-flow EC-IC bypasses were performed over the 8-year period. Sixty-five bypasses were performed by using RAGs and 15 were performed with SVGs. The average flow was 133 mL/min for RAGs and 160 mL/min for SVGs (P = .25). For both RAG and SVG groups, the donor and recipient vessel selected significantly impacted flow. For the RAG group only, preoperative graft diameter, postoperative hematocrit, and postoperative date significantly influenced flow. A 1-week average of >200 mL/min was 100% sensitive to cerebral hyperemia syndrome.CONCLUSION: This study establishes the normative range of duplex ultrasonographic flow after high-flow EC-IC bypass, as well the usefulness and practicality of such monitoring as a surrogate to flow in the postoperative period.