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Detection of Technical Error During Arterial Surgery by Pulsed Doppler Spectral Analysis

Detection of Technical Error During Arterial Surgery by Pulsed Doppler Spectral Analysis Abstract • Pulsed Doppler spectral analysis of midstream flow was compared with arteriography in 90 patients following carotid endarterectomy (N=60) or lower-extremity bypass grafting (N = 30) for the detection of unsuspected technical error. Spectral changes in the velocity waveform indicating flow disturbance were identified in the endarterectomy or anastomotic sites of 11 patients (12%). All were associated with an anatomic defect apparent on arteriography. The revision of major defects in six patients (7%) corrected the flow disturbance. The absence of flow disturbance in 79 patients (88%) predicted a technically satisfactory arterial reconstruction. Intraoperative assessment by pulsed Doppler spectral analysis is a noninvasive, rapid, and accurate method for detecting technical errors during arterial surgery. The high sensitivity of this method makes it suitable for use as a screening test, resulting In the selective use of operative arteriography. (Arch Surg 1984;119:421-428) References 1. Renwick S, Royle JP, Martin P: Operative angiography after femoropopliteal artery reconstruction: Its influence on early failure rate . Br J Surg 1968;55:134-136.Crossref 2. Collins GJ, Rich NM, Anderson CA, et al: Stroke associated with carotid endarterectomy . Am J Surg 1978;135:221-225.Crossref 3. Bowald S, Ericksson I, Fagerberg S: Intraoperative angiography in arterial surgery . Acta Chir Scand 1978;144:463-469. 4. Plecha FR, Pories WJ: Intraoperative angiography in the immediate assessment of arterial reconstruction . Arch Surg 1972;105:902-907.Crossref 5. Blaisdell FW, Lim R Jr, Hall AD: Technical result of carotid endarterectomy: Arteriographic assessment . Am J Surg 1967;114:239-246.Crossref 6. Rosental JJ, Gaspar MR, Movius HJ: Intraoperative arteriography in carotid thromboendarterectomy . Arch Surg 1973;106:806-808.Crossref 7. Anderson CA, Collins GJ, Rich NM: Routine operative arteriography during carotid endarterectomy: A reassessment . Surgery 1978;83:67-73. 8. Fell G, Phillips DJ, Chikos PM, et al: Ultrasonic duplex scanning for disease of the carotid artery . Circulation 1981;64:1191-1195.Crossref 9. Thiele BL, Hutchison KJ, Greene FM, et al: Pulsed Doppler waveform patterns produced by smooth stenosis in the dog thoracic aorta , in Tayler DEM, Stevens AL (eds): Blood Flow Theory and Practice . Academic Press Inc, New York, 1983, pp 85-104. 10. Bandyk DF, Zierler RE, Berni GA, et al: Pulsed Doppler velocity patterns produced by arterial anastomoses . Ultrasound Med Biol 1983;9: 79-87.Crossref 11. Zierler RE, Bandyk DF, Berni FA, et al: Intraoperative pulsed Doppler assessment of carotid endarterectomy . Ultrasound Med Biol 1983;9:65-71.Crossref 12. Zierler RE, Roederer GO, Strandness DE Jr: The use of frequency analysis in carotid artery surgery , in Bergan JJ, YAO JST (eds): Cerebrovascular Insufficiency . Grune & Stratton Inc, New York, pp 137-163. 13. Dardik H, Ibrahim IM, Koslow A, et al: Evaluation of intraoperative arteriography as a routine for vascular reconstructions . Surg Gynecol Obstet 1978;147:853-858. 14. Phillips DJ, Greene FM, Langlois Y, et al: Flow velocity patterns in the carotid bifurcations of young, presumed normal subjects . Ultrasound Med Biol 1983;9:39-49.Crossref 15. Sigel B, Coelha JC, Flanigan DP, et al: Detection of vascular defects during operation by imaging ultrasound . Ann Surg 1982;196:473-480.Crossref 16. Imparato AM, Bracco A, Kin GE, et al: Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions . Surgery 1972;72:1007-1017. 17. Sproul G, Pinto JM, Trummer MJ: Reoperation for early complications of arterial surgery . Arch Surg 1972;104:814-816.Crossref 18. LiCalzi LK, Stansel HC: Failure of autogenous reversed saphenous vein femoropopliteal grafting: Pathophysiology and prevention . Surgery 1982;91:352-358. 19. Towne JB, Bernhard VM: Neurologic deficit following carotid endarterectomy . Surg Gynecol Obstet 1982;154:849-852. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Detection of Technical Error During Arterial Surgery by Pulsed Doppler Spectral Analysis

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1984.01390160051011
Publisher site
See Article on Publisher Site

Abstract

Abstract • Pulsed Doppler spectral analysis of midstream flow was compared with arteriography in 90 patients following carotid endarterectomy (N=60) or lower-extremity bypass grafting (N = 30) for the detection of unsuspected technical error. Spectral changes in the velocity waveform indicating flow disturbance were identified in the endarterectomy or anastomotic sites of 11 patients (12%). All were associated with an anatomic defect apparent on arteriography. The revision of major defects in six patients (7%) corrected the flow disturbance. The absence of flow disturbance in 79 patients (88%) predicted a technically satisfactory arterial reconstruction. Intraoperative assessment by pulsed Doppler spectral analysis is a noninvasive, rapid, and accurate method for detecting technical errors during arterial surgery. The high sensitivity of this method makes it suitable for use as a screening test, resulting In the selective use of operative arteriography. (Arch Surg 1984;119:421-428) References 1. Renwick S, Royle JP, Martin P: Operative angiography after femoropopliteal artery reconstruction: Its influence on early failure rate . Br J Surg 1968;55:134-136.Crossref 2. Collins GJ, Rich NM, Anderson CA, et al: Stroke associated with carotid endarterectomy . Am J Surg 1978;135:221-225.Crossref 3. Bowald S, Ericksson I, Fagerberg S: Intraoperative angiography in arterial surgery . Acta Chir Scand 1978;144:463-469. 4. Plecha FR, Pories WJ: Intraoperative angiography in the immediate assessment of arterial reconstruction . Arch Surg 1972;105:902-907.Crossref 5. Blaisdell FW, Lim R Jr, Hall AD: Technical result of carotid endarterectomy: Arteriographic assessment . Am J Surg 1967;114:239-246.Crossref 6. Rosental JJ, Gaspar MR, Movius HJ: Intraoperative arteriography in carotid thromboendarterectomy . Arch Surg 1973;106:806-808.Crossref 7. Anderson CA, Collins GJ, Rich NM: Routine operative arteriography during carotid endarterectomy: A reassessment . Surgery 1978;83:67-73. 8. Fell G, Phillips DJ, Chikos PM, et al: Ultrasonic duplex scanning for disease of the carotid artery . Circulation 1981;64:1191-1195.Crossref 9. Thiele BL, Hutchison KJ, Greene FM, et al: Pulsed Doppler waveform patterns produced by smooth stenosis in the dog thoracic aorta , in Tayler DEM, Stevens AL (eds): Blood Flow Theory and Practice . Academic Press Inc, New York, 1983, pp 85-104. 10. Bandyk DF, Zierler RE, Berni GA, et al: Pulsed Doppler velocity patterns produced by arterial anastomoses . Ultrasound Med Biol 1983;9: 79-87.Crossref 11. Zierler RE, Bandyk DF, Berni FA, et al: Intraoperative pulsed Doppler assessment of carotid endarterectomy . Ultrasound Med Biol 1983;9:65-71.Crossref 12. Zierler RE, Roederer GO, Strandness DE Jr: The use of frequency analysis in carotid artery surgery , in Bergan JJ, YAO JST (eds): Cerebrovascular Insufficiency . Grune & Stratton Inc, New York, pp 137-163. 13. Dardik H, Ibrahim IM, Koslow A, et al: Evaluation of intraoperative arteriography as a routine for vascular reconstructions . Surg Gynecol Obstet 1978;147:853-858. 14. Phillips DJ, Greene FM, Langlois Y, et al: Flow velocity patterns in the carotid bifurcations of young, presumed normal subjects . Ultrasound Med Biol 1983;9:39-49.Crossref 15. Sigel B, Coelha JC, Flanigan DP, et al: Detection of vascular defects during operation by imaging ultrasound . Ann Surg 1982;196:473-480.Crossref 16. Imparato AM, Bracco A, Kin GE, et al: Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions . Surgery 1972;72:1007-1017. 17. Sproul G, Pinto JM, Trummer MJ: Reoperation for early complications of arterial surgery . Arch Surg 1972;104:814-816.Crossref 18. LiCalzi LK, Stansel HC: Failure of autogenous reversed saphenous vein femoropopliteal grafting: Pathophysiology and prevention . Surgery 1982;91:352-358. 19. Towne JB, Bernhard VM: Neurologic deficit following carotid endarterectomy . Surg Gynecol Obstet 1982;154:849-852.

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1984

References