April 1984

Detection of Technical Error During Arterial Surgery by Pulsed Doppler Spectral Analysis

Author Affiliations

From the Department of Surgery, Medical College of Wisconsin, Milwaukee, and the Surgical Services, Veterans Administration Medical Center, Wood, Wis (Dr Bandyk); and the Seattle VA Medical Center (Drs Zierler and Thiele).

Arch Surg. 1984;119(4):421-428. doi:10.1001/archsurg.1984.01390160051011

• Pulsed Doppler spectral analysis of midstream flow was compared with arteriography in 90 patients following carotid endarterectomy (N=60) or lower-extremity bypass grafting (N = 30) for the detection of unsuspected technical error. Spectral changes in the velocity waveform indicating flow disturbance were identified in the endarterectomy or anastomotic sites of 11 patients (12%). All were associated with an anatomic defect apparent on arteriography. The revision of major defects in six patients (7%) corrected the flow disturbance. The absence of flow disturbance in 79 patients (88%) predicted a technically satisfactory arterial reconstruction. Intraoperative assessment by pulsed Doppler spectral analysis is a noninvasive, rapid, and accurate method for detecting technical errors during arterial surgery. The high sensitivity of this method makes it suitable for use as a screening test, resulting In the selective use of operative arteriography.

(Arch Surg 1984;119:421-428)