RU2702872C2 - Diagnostic method for para-anastomotic aneurysms following aorto-femoral bypass surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ultrasonic diagnostics, and can be used for diagnosing para-anastomotic aneurysms after aorto-femoral bypass. Inguinal region is inspected in the longitudinal and transverse plane relative to the femoral artery. Anastomosis centre is determined in a longitudinal scanning plane. Thereafter, the transducer is converted into a transverse plane. Distance between the edges of the prosthesis is measured. If the distance is not less than 17 mm, the presence of a para anastomotic aneurysm is diagnosed.

EFFECT: method enables early diagnosis of para-anastomotic aneurysms, which is unrestricted in use in patients with excessive body weight by determining the distance between the edges of the prosthesis by an ultrasonic technique.

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Description

The invention relates to medicine, namely to radiation diagnostics, cardiovascular surgery, and can be used to diagnose the development of aneurysms of distal anastomoses (paraanastomotic aneurysms).

W. Ultrasonography in Vascular Diagnosis. A Therapy-Oriented Textbook and Atlas. 2^nd Edition. - Springer, 2011. - 541 p., Thrush A., Hartshorn T. Peripheral Vascular Ultrasound. How, Why and When. - Elsevier, 2005. - 235 p., 4. Zwiebel W.J., Pellerito J. Introduction to Vascular Ultrasonography. - Sauders, 2005. - 723 p).Diagnosis of paraanastomotic aneurysms is based on the use of medical imaging methods, primarily ultrasound (

W. Ultrasonography in Vascular Diagnosis. A Therapy-Oriented Textbook and Atlas. 2 ^nd Edition. - Springer, 2011 .-- 541 p., Thrush A., Hartshorn T. Peripheral Vascular Ultrasound. How, Why and When. - Elsevier, 2005. - 235 p., 4. Zwiebel WJ, Pellerito J. Introduction to Vascular Ultrasonography. - Sauders, 2005 .-- 723 p).

Most of these methods are limited to describing the clinical manifestations of aneurysms, which have reached significant sizes, available for palpation or visual determination. Thus, aneurysms are detected in most cases at a late stage or with the development of complications (rupture, thrombosis). An ultrasound or angiographic study is used to confirm the diagnosis.

Closest to the claimed is a method of ultrasound diagnosis of aneurysms of distal anastomoses based on the detection of expansion of the lumen of the vessel in the region of the anastomosis, the walls of which are formed by scar connective tissue and prosthetic material, by measuring the transverse and anteroposterior size (Lelyuk V.G., Lelyuk S.E. Ultrasonic Angiology. - M.: Realnoe Vremya. - P. 288).

The disadvantages of the method selected as a prototype are:

- technical complexity due to the need to determine the boundaries of the vessel in the depths of the tissues and the differentiation of the wall from the layer of thrombotic masses;

- the expected high frequency of false negative results in the early stages of aneurysm formation;

- lack of ability to standardize measurements and, therefore, dynamic observation.

The objective of the invention is to simplify the procedure.

The technical result of the task is achieved by the fact that in the method for the diagnosis of paraanastomotic aneurysms, based on ultrasound examination of the inguinal region and measuring the size of the anastomosis, the distance between the edges of the prosthesis is measured and, if this distance is at least 17 mm, the presence of paraanastomotic aneurysm is diagnosed.

One of the differences is the measurement of the distance between the edges of the prosthesis, which is carried out in the “near” field of scanning and, accordingly, in the area accessible for clear visualization in all cases, regardless of the ultrasound equipment used, the qualifications of the specialist and the thickness of the subcutaneous fat of the patient. At the same time, there is no need to detect the posterior wall of the anastomosis and its differentiation from the layer of thrombotic masses, as well as the maximum transverse size, which simplifies the study, shortens its time and ensures reproducibility in all cases.

The second difference is the use of a universal criterion in the form of the distance between the edges of the prosthesis, an increase of which to 17 or more mm corresponds to the true diameter of the anastomosis of 25 or more mm, in other words, to the presence of aneurysmal expansion. Evaluation of the criterion does not depend on the type of anastomosis and the diameter of the vascular prosthesis and allows the aneurysm to be detected at the earlier stage of development of expansion.

The method is as follows. Any type of ultrasonic sensor is used. In the inguinal region, scanning is performed in the longitudinal and transverse planes relative to the course of the femoral artery. In the longitudinal plane of the scan, the center of the anastomosis is determined, after which the sensor is transferred to the transverse plane. The edges of the vascular prosthesis are determined, which are well visualized due to the hyperechoogenicity of the prosthesis material. The distance between the edges is measured. In the event that this indicator is 17 mm or more, the fact of the presence of a paraanastomotic aneurysm can be established. In those cases when in a series of consecutive measurements an increase of 2 or more mm is noted, the patient is subject to dynamic observation due to the risk of formation of a paraanastomotic aneurysm.

Example. Patient D., born in 1945, suffering from severe obesity (body mass index 42 kg / m ² ). In 2010, he underwent aorto-femoral bypass surgery. No complaints. During external examination in the inguinal regions, protrusions were not determined. On palpation, additional information was not received. November 27, 2013, 34 months after the operation, when conducting ultrasound in the groin on the left, visualization of the posterior wall of the anastomosis is difficult due to the depth of the location (subcutaneous tissue thickness is more than 13 cm). Diagnostics by the claimed method. The front wall of the anastomosis was visualized, with a transverse scan, the distance between the edges of the prosthesis was measured, which was 19 mm. The presence of a distal anastomosis aneurysm is suspected, confirmed by the data of an angiographic study. An operation was performed during which a paraanastomotic aneurysm with a diameter of 48 mm was detected.

The inventive method is simple, reproducible and highly effective in the early diagnosis of paraanastomotic aneurysms.

It is available to doctors of any specialty, is not limited in use in patients with overweight.

Claims (1)

A method for diagnosing paraanastomotic aneurysms after aorto-femoral bypass surgery, including ultrasound (ultrasound), characterized in that an ultrasound of the inguinal region is performed in the longitudinal and transverse planes relative to the course of the femoral artery, the center of the anastomosis is determined in the longitudinal plane of the scan, after which the sensor is transformed into the transverse plane and measure the distance between the edges of the prosthesis, with a value of this distance of at least 17 mm, the presence of a paraanastomotic aneurysm is diagnosed.