Journal of Ultrasound in Medicine, Vol 2, Issue 8 337-343, Copyright © 1983 by American Institute of Ultrasound in Medicine
Imaging ultrasound in the intraoperative diagnosis of vascular defects
B. Sigel, D. P. Flanigan, J. J. Schuler, J. Machi, J. C. Beitler and J. C. Coelho
High-resolution real-time ultrasonography was employed during 267 vascular
operations in order to diagnose vascular defects such as intimal flaps,
strictures, and thrombi. These defects occur at operative areas (e.g.,
anastomoses, endarterectomized segments, and sites of placement of
occlusive clamps) and can lead to serious thrombotic complications in the
early post-operative period. Ultrasound detected vascular defects in 83
patients (31.1 per cent). The defects in 59 patients were considered
clinically insignificant because of their sizes and locations, and were not
re-explored. Early post-operative results of these patients were comparable
to those of the patients without demonstrated defects. In 24 patients (9.0
per cent of all patients examined), ultrasonography revealed clinically
significant defects which prompted re-exploration. In 20 of these 24
patients, these vascular defects were confirmed and corrected. No defect
was found at re-exploration in four patients, but two of them developed
early postoperative thrombosis. Ultrasonography and arteriography were
compared at 100 operative sites. The two imaging methods were equal in
terms of sensitivity, specificity, efficiency, and predictability of a
negative test. Predictability of a positive test was 77.8 per cent for
ultrasonography and 59.1 per cent for arteriography. This indicates that
fewer needless re-explorations would occur following a decision based on
ultrasonography. Operative ultrasonography is a simple, safe and accurate
technique that should be applied to reconstructive vascular surgery for
diagnosis of vascular defects.
