超声判断锁骨下动脉在冠状动脉旁路移植术应用的价值

目的:探讨冠状动脉旁路移植(CABG)术前常规超声检查锁骨下动脉的价值。方法:超声检查拟CABG术患者1546例共3092条锁骨下动脉,分析锁骨下动脉狭窄及同侧椎动脉、乳内动脉的血流频谱情况,发现锁骨下动脉中度以上狭窄时以血管造影为金标准,评价椎动脉及乳内动脉逆流诊断锁骨下动脉狭窄的价值。结果:103例患者(124条锁骨下动脉)存在锁骨下动脉起始段中度以上狭窄,狭窄发生率为6.7%。锁骨下动脉狭窄侧椎动脉逆流51条,无逆流73条,余锁骨下动脉无狭窄侧椎动脉均无逆流;锁骨下动脉狭窄侧乳内动脉逆流11条,无逆流113条,余锁骨下动脉无狭窄侧乳内动脉均无逆流。以椎动脉逆流诊断同侧锁骨下动脉狭窄的敏感性为41.1%,特异性为100%,ROC曲线下面积为0.706;以乳内动脉逆流诊断同侧锁骨下动脉狭窄的敏感性为8.87%,特异性为100%,ROC曲线下面积为0.544。结论:根据椎动脉及乳内动脉逆流诊断同侧锁骨下动脉狭窄的价值均较低,常规超声检查锁骨下动脉对指导CABG术桥血管选择避免出现冠状动脉锁骨下动脉窃血综合征是非常重要的。

The value of ultrasound in judging subclavian artery in coronary artery bypass grafting

Objective:To investigate the value of ultrasound examination of subclavian artery before coronary artery bypass grafting.Methods:Ultrasound examination was performed in 1546 patients(a total of124 sides subclavian artery)undergoing CABG,to analysis whether subclavian artery has stenosis or not,and the blood flow spectrum of ipsilateral vertebral artery and internal mammary artery.When the moderate or above subclavian artery stenosis was found,angiography was used as the gold standard to evaluate the value of vertebral artery and internal mammary artery counterflow in predicting subclavian artery stenosis.Results:103 patients(a total of 124 sides)had moderate or above stenosis of the subclavian artery,the detection rate was6.66%.In the side of subclavian artery stenosis,the ipsilateral vertebral artery had counterflow were 51 sides,without counterflow were 73 sides,there was no counterflow in the vertebral artery in the side of the remaining subclavian artery without stenosis.In the side of subclavian artery stenosis,the internal mammary artery had counterflow were 11 sides,without counterflow were 113 sides,there was no counterflow in the internal mammary artery in the side of the remaining subclavian artery without stenosis.The sensitivity,specificity and area under ROC curve of vertebral artery counterflow for predicting ipsilateral subclavian artery stenosis were 41.1%,100%and 0.706 respectively.The sensitivity,specificity and area under ROC curve of internal mammary artery counterflow for predicting ipsilateral subclavian artery stenosis were 8.87%,100%and 0.544 respectively.Conclusions:The value of vertebral artery and internal mammary artery counterflow in diagnosing ipsilateral subclavian artery stenosis is low.Routine ultrasound examination of subclavian artery is very important to guide the selection of bridging vessels to avoid the occurrence of coronary subclavian steal syndrome.