Detection of vascular defects during operation by imaging ultrasound

Real-time high resolution ultrasound imaging was employed during reconstructive vascular operation in 165 patients. The purpose of this diagnostic procedure was to detect unrecognized strictures, thrombi, and intimal flaps in order to permit their surgical correction at the primary operation. Defects were discovered in 48 patients (29%). In 34 patients (21%), because of size and location, defects were not considered sufficiently significant to warrant re-exploration. In 14 patients (8%), ultrasound revealed defects that prompted immediate re-exploration. Patients with ultrasound defects considered to be insignificant did as well as patients with no demonstrable defects. In the 14 patients who were re-explored, 12 had major defects that were corrected. These 12 patients also did well after operation. In two of the 14 patients, defects could not be found at re-exploration. Both these patients experienced early thrombosis of bypass grafts. In 56 patients, ultrasound was compared with arteriography at the same operation. The accuracy of operative ultrasound and operative arteriography was 96% and 85%, respectively. Operative ultrasound is more accurate, simpler and safer than arteriography and may be the preferred method for detection of vascular defects at reconstructive surgery.