Abstract
Vascular reconstructions carry a high risk of early and late failure, leading potentially to major problems. Therefore, it is crucial to ensure the quality of reconstructions at the end of every operation. No method has been shown to be superior to others and it is beneficial for the vascular surgeons to master many techniques. Transit time flow measurement (TTFM) is a fast and easy way to directly evaluate the desired end result; blood flow to the end organ. It is not problem-free nor totally reliable. In addition to TTFM different quality control methods including their pros and cons are discussed.
Zusammenfassung
Gefäßrekonstruktionen gehen mit einem hohen Risiko des frühen und späten Versagens einher, was zu erheblichen Schwierigkeiten führen kann. Entsprechend ist es äußerst wichtig, am Ende jedes Eingriffs die Qualität der Rekonstruktionen sicherzustellen. Kein dabei eingesetztes Verfahren war in Studien anderen Verfahren überlegen. Gefäßchirurgen profitieren daher davon, viele Verfahren sicher zu beherrschen. Die laufzeitbasierte Flussmessung (TTFM) ist eine schnelle und einfache Methode, um auf direktem Weg das gewünschte Endergebnis, nämlich den Blutstrom zum Endorgan, zu beurteilen. Das Verfahren ist allerdings nicht frei von Schwierigkeiten und auch nicht gänzlich zuverlässig. Neben der TTFM werden weitere Methoden der Qualitätssicherung mit ihren Vor- und Nachteilen erörtert.
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References
Woo K, Palmer OP, Weaver FA, Rowe VL, Society for Vascular Surgery Quality Initiative (2015) Outcomes of completion imaging for lower limb extremity bypass in the Vascular Quality Initiative. J Vasc Surg 62:412–416
Kim AH, Shevitz AJ, Morrow KL, Kendrick DE, Harth K, Baele H, Kashyap VS (2017) Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography. J Vasc Surg 66:146–172
Aho PS, Venermo M (2012) Hybrid procedures as a novel technique in the treatment of critical limb ischemia. Scand J Surg 101:107–113
Johnson BL, Bandyk DF, Back MR, Avino AJ, Roth SM (2000) Intraoperative duplex monitoring of infrainguinal vein bypass procedures. J Vasc Surg 31:678–690
Vascular study group of New England, Tan T‑W, Rybin D, Kalish JA, Doros G, Hamburg N, Schanzer A, Cronenwett JL, Farber A et al (2014) Routine use of completion imaging after infrainguinal bypass is not associated with higher bypass graft patency. J Vasc Surg 60:678–685
Sharpe R, Sayers RD, McCarthy MJ, Dennis M, London NJ, Nasim A, Bown MJ, Naylor AR (2012) The war against error: a 15 year experience of completion angioscopy following carotid endarterectomy. Eur J Vasc Endovasc Surg 43:139–145
Grundfest WS, Litvack F, Glick D, Segalowitz J, Treiman R, Cohen L, Foran R, Levin P, Cossman D, Carroll R et al (1988) Intraoperative decisions based on angioscopy in peripheral vascular surgery. Circulation 78:I13–7
Unno N, Suzuki M, Yamamoto N, Inuzuka K, Sagara D, Nishiyama M, Tanaka H, Konno H (2008) Indocyanine green fluorescence angiography for intraoperative assessment of blood flow: a feasibility study. Eur J Vasc Endovasc Surg 35:205–207
Venermo M, Settembre N, Albäck A, Vikatmaa P, Aho PS, Lepäntalo M, Inoue Y, Terasaki H (2016) Pilot assessment of the repeatability of Indocyanine green fluorescence imaging and correlation with traditional foot perfusion assessments. Eur J Vasc Endovasc Surg 52:527–533
Drost CJ (1978) Vessel diameter-independent volume flow measurements using ultrasound. Proc San Diego Biomed Symp 17:299
Laustsen J, Pedersen EM, Terp K, Steinbrüchel D, Kure HH, Paulsen PK, Jørgensen H, Paaske WP (1996) Validation of a new transit time ultrasound flowmeter in man. Eur J Vasc Endovasc Surg 12:91–96
Albäck A, Mäkisalo H, Nordin A, Lepäntalo M (1996) Validity and reproducibility of transit time flowmetry. Ann Chir Gynaecol 85:325–331
Pedersen G, Laxdal E, Amundsen SR, Dregelid E, Jonung T, Nyheim T, Aune S (2006) Flow measurement before and after papaverine injection in above-knee prosthetic femoropopliteal bypass. J Vasc Surg 43:729–734
Albäck A, Roth W‑D, Ihlberg L, Biancari F, Lepäntalo M (2000) Preoperative angiographic score and intraoperative flow as predictors of the mid-term patency of infrapopliteal bypass grafts. Eur J Vasc Endovasc Surg 20:447–453
Thul R, Heckenkamp J, Gawenda M, Reichert V, Aleksic M, Brunkwall J (2007) Der Effect der intraoperativen Prostavasingabe bei kruraler Bypasschirurgie. Zentralbl Chir 132:485–490
Aleksic M, Brunkwall J (2009) Extracranial blood flow distribution during carotid endarterectomy. Eur J Vasc Endovasc Surg 38:552–555
Aleksic M, Matoussevitch V, Heckenkamp J, Brunkwall J (2006) Changes in internal carotid blood flow after CEA evaluated by transit-time flowmeter. Eur J Vasc Endovasc Surg 31:14–17
Eckstein HH, Eichbaum M, Klemm K, Doerfler A, Ringleb P, Bruckner T, Allenberg JR (2003) Improvement of carotid blood flow after carotid endarterectomy—evaluation using intraoperative ultrasound flow measurement. Eur J Vasc Endovasc Surg 25:168–174
Matsumura H, Ito Y, Uemura K, Komatsu Y, Ishikawa E, Matsumaru Y, Matsumura A (2018) Prediction of hyperperfusion phenomenon after carotd endarterectomy by transit time flowmeter. Abstract presented at World federation of neurosurgical societies symposia, Kuala Lumpur
Ascher E, Markevich N, Hingorani AP, Kallakuri S, Gunduz Y (2002) Internal carotid artery flow volume measurement and other intraoperative duplex scanning parameters as predictors of stroke after carotid endarterectomy. J Vasc Surg 35:439–444
Heinola I, Halmesmäki K, Kantonen I, Vikatmaa P, Aho P, Lepäntalo M, Venermo M (2016) Temporary axillorenal bypass in complex aorto-renal surgery. Ann Vasc Surg 31:239–245
Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, Kolkman JJ, Lees T, Lefevre JH, Menyhei G, Oderich G, Esvs Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Sanddal Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Geelkerken B, Gloviczki P, Huber T, Naylor R (2017) Editor’s choice—management of the diseases of Mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 53:460–510
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P. Vikatmaa is the treasurer of the European Society for Vascular Surgery. P. Vikatmaa and A. Albäck declare that they have no competing interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
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Vikatmaa, P., Albäck, A. Intraoperative quality control with transit time flow measurement. Gefässchirurgie 23, 580–585 (2018). https://doi.org/10.1007/s00772-018-0477-6
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DOI: https://doi.org/10.1007/s00772-018-0477-6