Intraoperative monitoring in vascular surgery.

Doppler ultrasound and real-time B-mode ultrasonic imaging are useful techniques to monitor the technical success of reconstructive vascular operations. Gas-sterilized CW or pulsed Doppler probes permit audible or spectral detection of normal and abnormal blood velocity patterns associated with intimal flaps, thrombotic or platelet aggregates, retained venous valve cusps or arteriovenous fistulas. Real-time ultrasonic B-mode imaging allows detection of technical defects or thrombotic debris which is of particular importance in minimizing stroke or recurrent lesions following carotid endarterectomy. These ultrasonic techniques should become routine adjuncts for surgeons interested in defining localized pathology and hemodynamics, assuring technical integrity, detecting intraoperative defects, and predicting favorable outcome of vascular reconstruction procedures.