The role of duplex and color Doppler imaging in the operating room

For years vascular surgeons have used objective methods in the operating room to assess the technical quality of vascular procedures. Black and white (duplex) and color Doppler imaging are critical to the preoperative work-up and postoperative follow-up of many patients. With advancing technology it is possible to adapt these imaging techniques for use in the operating room as well. Anatomic and hemodynamic results can therefore be ascertained before the patient leaves the operating room. Over the past 31 months, vascular surgeons at St. John's Mercy Medical Center (SJMMC) have regularly used duplex and color Doppler imaging in the operating room after carotid thromboendarterectomy and renal artery bypass. A peripheral vascular laboratory nurse is called to the operating room and brings the imaging equipment and videotape recorder. The imaging transducer is draped with a sterile sheath and positioned directly on the vessel. Longitudinal and transverse views are obtained; the presence of intimal flap or turbulent color flow is noted. Sound spectral analysis and peak systolic velocity are obtained in centimeters per second (cm/sec) at various locations proximal and distal to the arteriotomy and within the graft or endarterectomized segment. Results are classified as normal or abnormal. Abnormal findings are further classified as accepted or warranting reexploration. Of 81 carotid scans, 55 (67%) were normal and 26 (33%) abnormal by imaging. Of 28 abnormal sites, 14 (17%) were reexplored and the abnormality repaired. The other 14 abnormalities were accepted. Duplex and color Doppler imaging have proved helpful to surgeons in assessing technical results before the patient leaves the operating room.(ABSTRACT TRUNCATED AT 250 WORDS)