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

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Abstract
• 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)