Intraoperative flow predicts the development of stenosis in infrainguinal vein grafts

Ihlberg, Leo; Albäck, N.Anders; Lassila, Riitta; Lepäntalo, Mauri

doi:10.1067/mva.2001.115812

Cited by 21 publications

(15 citation statements)

References 51 publications

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“…11 Intraoperative Duplex assessment of grafts appears to be the most useful modality to assess graft function and may have the ability to predict future stenotic development and graft failure. 9,18,19 Duplex assessment, however, is user dependent and subject to wide interoperator variability and thus there may be advantages to using a device capable of standardizing measurements graft flow and resistance, such as the OpDop. A number of studies have assessed completion Doppler spectral analysis of graft flow and resistance, but these have generated conflicting results.…”

Section: Discussionmentioning

confidence: 98%

Patency of infra-inguinal vein grafts – effect of intraoperative Doppler assessment and a graft surveillance program

Hobbs

Pinkney

Sykes

et al. 2009

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 98%

Patency of infra-inguinal vein grafts – effect of intraoperative Doppler assessment and a graft surveillance program

Hobbs

Pinkney

Sykes

et al. 2009

Journal of Vascular Surgery

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“…In reconstructions with higher intraoperatively measured flow, long term patency is better and grafts develop less stenotic changes [11].…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance and Prognostic Value of Preoperative Angiographic Assessment in Infrainguinal Arterial Reconstructions

Cheshmedzhiev

Jordanov

Yordanov

et al. 2014

Journal of Angiology

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Objective. To assess the practical implementation of the modified Schwierz T. system for angiographic scoring of the arteries below the distal anastomosis (run-off) after infrainguinal reconstructions. Methods. We used the modified Schweierz T. score, which is readily practically applied in each patient for assessment of the run-off segment, independently from the planned level of distal anastomosis. 97 consequently treated patients who underwent infrainguinal arterial reconstructions were followed up during a 12-month period, and we retrospectively compared the results of two groups-48 of failed and 49 of patent bypasses; as for the long term patency there were some discrepancies with the expected good results. Measurements of the flow volume were performed below distal anastomoses in peripheral bypass operations with flowmeter VeriQ, Medistim, Oslo, Norway. Flowmetry was performed before and after a 5-minute infusion of Prostavasin or Ilomedin, causing peripheral vasodilatation. The resulting values were averaged and compared to the beforehand calculated according to the Schwierz score minimal expected flow. Results. Schwierz score gives orientation immediately after the reconstruction about the early patency of the bypass. Control angiographies and revisions in cases with inadequate minute blood flow identify some mistakes, the correction of which (if possible) in one operation time improves the results and the early patency. 9% of the failed bypasses in the first month had blood flow above the expected and 37% of the failed bypasses in the eighth month had flow above the expected. Mismatch in the patent bypasses was observed in 6%, probably due to subjective underestimation of some collateral vessels. Conclusion. Quantification of the distal flow is very important. The suggested model of assessment must determine as exactly as possible minimal flow to be reached at the end of the operation. We consider the preoperative angiographically calculated expected blood flow, good additional criteria for the quality of the newly constructed bypass. Intraoperative registration of low blood flow has the significance of screening for further assessment through intraoperative arteriography for the morphological identification of the cause. Having in mind the subjective nature of the angiographic scoring system and its dependence on the quality of the image, we consider the preoperative angiographic estimated expected volume of flow referring to the early patency adequate and inappropriate for long term prediction, but useful as an accessory orientation measurement of the state of the run-off arteries and the result of the surgery.

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“…1 The structural adaptation of vein grafts has been intimately linked to the local hemodynamic environment. Based on animal experimentation 2–4 and clinical observation, 5, 6 wall shear stress (WSS) has been identified as a key hemodynamic parameter during this adaptation process and the standard paradigm of vascular remodeling has been established, where a reduction in WSS accelerates the intimal hyperplasic response and leads to luminal narrowing. Resulting from the reduced luminal diameter, WSS increases and the rate of intimal growth and further luminal narrowing is diminished.…”

Section: Introductionmentioning

confidence: 99%

Flow reversal promotes intimal thickening in vein grafts

Fernandez

Jiang

et al. 2014

Journal of Vascular Surgery

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Objective Following vascular interventions, unidentified mechanisms disrupt the homeostasis of a focal narrowing to initiate an intimal thickening response. We hypothesize that perturbations in the hemodynamic microenvironment are the initiating event for this disruption of homeostasis and intimal thickening in vein bypass grafts. The objective of this study was to investigate the relation between local flow perturbations and its influence on the vein graft architecture. Methods An external ligature was used to create an 80% focal mid-graft stenosis in bilateral rabbit carotid vein grafts. A unilateral distal ligation created a 9-fold flow rate difference between high and low flow grafts. Vein grafts (n=10) were harvested at 28 days and serially sectioned for morphologic evaluation and vein graft reconstruction. Computational fluid dynamics analyses were performed to examine the hemodynamic environment within these complex flow regions. Results The largest intimal thickening occurred exclusively within the region immediately distal to the maximum stenosis in high flow grafts, which was characterized by persistent flow separation and reversal for the entire cardiac cycle. In low to moderate shear stress regions, less than 5 Pa, the typical inverse correlation between intimal thickness and wall shear was observed. Conclusions Regions of vein bypass grafts exposed to persistent flow reversal are most at risk for intimal thickening and loss of lumen.

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Intraoperative flow predicts the development of stenosis in infrainguinal vein grafts

Abstract: Intraoperative graft volume flow is a predictor of bypass occlusion after infrainguinal bypass. In addition, this study verifies an association between the development of clinically evident graft stenoses and low graft flow.

Cited by 21 publications

References 51 publications

Patency of infra-inguinal vein grafts – effect of intraoperative Doppler assessment and a graft surveillance program

Patency of infra-inguinal vein grafts – effect of intraoperative Doppler assessment and a graft surveillance program

Clinical Significance and Prognostic Value of Preoperative Angiographic Assessment in Infrainguinal Arterial Reconstructions

Flow reversal promotes intimal thickening in vein grafts

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