Intraoperative duplex ultrasound of visceral revascularizations: optimizing technical success and outcome.

Abstract

The purpose of this study was to evaluate the use of intraoperative duplex ultrasound scanning (IOUS) during visceral revascularizations and correlate its results with clinical outcome. We studied 68 patients (15 men and 53 women, mean age 66.5 years, range 27-86 years) who underwent visceral revascularization with concomitant IOUS examination of 120 visceral arteries (52 celiac, 60 superior mesenteric, and 8 inferior mesenteric arteries) from 1992 to 2002. Patients were divided into two groups on the basis of ultrasound findings: normal and abnormal IOUS. The incidence of early and late graft-related complications (thrombosis, restenosis, recurrent symptoms, reintervention) and graft-related death was compared in both groups. One-hundred and two (85%) arteries had normal IOUS. Eight (6.6%) arteries had minor defects, including small kinks (4), mild residual stenoses (3), and small intimal flap (1). Ten (8.4%) arteries had major defects, consisting of hemodynamically significant residual stenoses (4), thrombus (2), kinks (2), bidirectional flow (1), and intimal flap (1). Major defects were successfully revised in all except three cases: two persistent mild stenoses and one bidirectional flow. Patients with abnormal IOUS at the end of the operation had increased incidence of graft-related complications and/or death (55.5% vs 7.8%; P =.004), early graft thrombosis (14.2% vs 1.0; P =.04), reintervention (21.4% vs 3.2%; P =.03), and graft-related death (33.3% vs 1.9%; P =.02), compared with patients with normal IOUS. This study supports the routine use of IOUS during visceral revascularizations to optimize technical success and outcome. Persistent ultrasound scanning abnormalities are associated with risk of early graft failure, reintervention, and death. Patients with normal ultrasound scans can expect excellent results.