Aortoiliac reconstructive surgery based upon the results of duplex scanning

Objective:to evaluate whether duplex scanning can replace angiography in patients operated for aortoiliac obstructive disease.Design:retrospective.Materials and methods:between January 1995 and October 1996, 44 patients underwent vascular surgery of the aortoiliac tract. The study population was divided into two groups; patients operated upon the results of duplex scanning only and patients who also underwent angiography prior to surgery. The additional value of angiography and the differences between both groups concerning unexpected peroperative findings, early postoperative failures and the need for additional radiological or surgical interventions in the first three postoperative months were studied.Results:Duplex scan group: 22 patients were operated upon the results of duplex scanning only. In two patients surgical strategy had to be changed. Early postoperative graft occlusion occurred in one case. A haemodynamically significant graft stenosis within 3 months of surgery occurred in one patient. Duplex/angiography group: 22 patients underwent both duplex scanning and angiography. Six patients underwent diagnostic angiography after failed duplex scanning. In 10 patients angiography was part of percutaneous transluminal angioplasty prior to surgery. In six patients angiograms were performed after successful duplex scanning. Angiography failed in two patients and added information in four of 16 patients. Unexpected findings at operation occurred in four patients. Graft stenosis within 3 months was detected in three patients.Conclusion:after successful duplex scanning information obtained by angiography has only a limited impact on therapeutic decision-making. In the majority of patients vascular reconstructive surgery of aortoiliac arteries can be planned based on duplex scanning only

Interobserver Variation of Colour Duplex Scanning of the Popliteal,Tibial and Pedal Arteries

AbstractObjectives: to determine interobserver variation in the measurement of Peak Systolic Velocity (PSV) and grading of disease by means of Duplex scanning (DS) in the popliteal, tibial and pedal arteries. Design: prospective validation study. Materials twenty-four consecutive patients with severe claudication (n=6), ischaemic rest pain (n=11) and tissue loss (n=7). Methods two vascular technologists independently examined the popliteal, tibial and pedal arteries. The PSV was recorded in 15 arterial segments that were graded with B-mode and Doppler parameters as fully patent, severely diseased or occluded. Concordance in PSV recordings was expressed as intraclass correlation coefficients (ICC). Agreement in artery assessment was expressed as weighted κ-values. Results the ICC for PSV measurements was 0.90 (95% CI, 0.86 to 0.93) within the popliteal and tibial arteries and 0.64 (95% CI, 0.37 to 0.81) within the pedal arteries. Agreement for grading disease was good within the popliteal and tibial arteries (κ 0.66, 95% CI, 0.58 to 0.74), and moderate within the pedal arteries (κ 0.54, 95% CI 0.33 to 0.74). The presence of diabetes or stage of disease did not influence interobserver agreement. Conclusion interobserver agreement of DS is good within the popliteal and tibial arteries and moderate within the pedal arteries

Morphology and function of preserved microvascular arterial grafts: an experimental study in rats

The aim of this study is to examine the morphology and function and small-caliber, arterial grafts after preservation in the University of Wisconsin solution (UW). Rat carotid arteries were stored in UW (n = 10) or in phosphate-buffered saline (PBS) (n = 10) for 1, 3, 7, and 14 days and were examined with light microscopy (LM) and scanning electron microscopy (SEM). Rat aortic preparations were stored in UW or PBS for 1 hour, 24 hours, 72 hours, 7 days, and 14 days and assessed for functional responses (stimulated contraction and endothelium-dependent relaxation). Segments (5 mm) of rat carotid arteries were stored in UW or PBS for 3 days, 7 days, and 14 days and orthotopically implanted as autografts and allografts. No immunosuppressive or anticoagulant agents were used. After 28 days of implantation, the grafts were assessed for patency and excised for LM and SEM. In UW, the endothelial layer remained intact up to 9 days of storage. In PBS, the endothelial layer showed deterioration after 1 day and was completely lost after 3 days. Functional responses were demonstrated to exist for as long as 7 days storage in UW. In PBS, no responses could be evoked after 24 hours storage. Autografts preserved in UW for 3 days (n = 6), 7 days (n = 6), and 14 days (n = 6) showed patency rates of 83.3%, 66.6%, and 66.6%, respectively, whereas patency rates of allografts were 66.6%, 33.3%, and 33.3%, respectively. Autografts stored in PBS for 3 days (n = 6), 7 days (n = 6), and 14 days (n = 6) showed patency rates of 33.3%, 33.3%, and 50%, respectively, whereas patency rates of allografts were 16.7%, 0%, and 33.3%, respectively. The UW preserved autografts showed normal morphology. All other groups showed vessel wall degeneration which in the allograft groups, were accompanied by lymphocellular infiltration. In conclusion, the endothelial layer and vessel wall of arteries are adequately preserved in UW. Functional responses are retained up to 14 days storage in UW, but, are lost after 24 hours storage in PBS. Autograft implantation studies accordingly show good performance of arterial segments preserved in UW, whereas allografts are subject to degradation as a result of rejectio