A New Assessment of Arteriographic Runoff for Predicting Fate of Femoropopliteal Arterial Reconstructions

Abstract

The preoperative arteriogram has been widely used to estimate distal vascular runoff in reconstructions of the lower extremity arteries. Based on the authors' previous reports that the intraoperative electromagnetically determined flow waveform of the reconstructed artery is a reliable predictor for the prognosis of the reconstructed artery, the correlation between intraoperative flow waveform pattern and preoperative arteriographic runoff in 60 femoropopliteal arterial reconstructions was analyzed. Preoperative arteriographic runoff was classified into five groups (Groups A, B, C, D, and E), according to presence of continuity of the popliteal artery with the calf arteries and the number of patent calf arteries and of patent calf arteries connecting the pedal arch. Arteriographic runoff with Type 0 or I flow waveform (n = 34) showed that two or three calf arteries were patent to the ankle and that at least two had continuity to the pedal arch (Groups A and B). On the contrary, the arteriograms showing Type II flow waveform (n = 26) revealed a variety of distal runoff from one patent calf artery connecting with the pedal arch to the isolated popliteal artery (Groups C, D, and E). Arteriographic runoff of two groups of flow waveform 0/I vs II could be clearly distinguished. These results were taken to mean that continuity of patent calf arteries with the pedal arch can serve as an important factor for evaluating vascular distal runoff in femoropopliteal arterial reconstructions. The authors' assessment of arteriographic runoff is a simple preoperative predictor for intraoperative flow waveform, namely, the outcome, of the reconstructed artery.