[Color duplex scanning in the evaluation of endovascular interventions into autovenous shunts]

The paper describes a role of color duplex scanning (CDS) in the assessment of results of endovascular interventions into autovenous shunts, including in situ ones. From 2000 to 2005, the unit of vascular surgery of Clinical Hospital No. 83 performed 148 femoropopliteal and femototibial repairs, including the in situ technique, in 138 patients with atherosclerosis obliterans and stenotic and occlusive changes in the femoropopliteal segment and shin arteries. CDS monitoring revealed 42 shunts with hemodynamically significant changes, which was an indication for preventive endovascular operations --balloon angioplasty (BAG) and in one case for autovenous shunt stenting. According to CDS data, an adequate endovascular intervention with restoration of the geometry of shunts or their anastomoses was performed in 40 (95.2%) cases, by recording the great bloodstream; there were hemodynamically significant complications (residual stenoses) in 2 (4.8%) cases and hemodynamically insignificant ones in 5 (12%). In the late period, hemodynamically significant complications (thromboses and restenoses of an angioplasty site) and insignificant restenoses were detected in 14 (33%) and 5 (12%) cases, respectively. After endovascular intervention, supplemented shunt patency was 40.89 +/- 18.5% with the average follow-up length of 23.3 +/- 2.3 months. Based on the complications detected at a hospital stage and in the late follow-up period after preventive primary endovascular intervention, 10 endovascular reinterventions were performed, which increased patency time in the group of endovascular reinterventions into the shunts by 19.6 +/- 3.8 months. Thus, the developed echosemiotics of shunts, including an in-situ autovenous shunt permits evaluation of the state of a shunt and the hemodynamic significance of the found changes in due time and early at surgery. CDS monitoring makes it possible to specify indications for preventive operations, to choose a repeated reparative procedure in a patient with thromboses of femoropopliteal and femorotibial segments.