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

Hobbs, Simon; Pinkney, Thomas; Sykes, Timothy C.F.; Fox, Arthur W.; Houghton, Andrew R

doi:10.1016/j.jvs.2009.02.002

Cited by 12 publications

(8 citation statements)

References 24 publications

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“…Invasive procedures do not improve the quality of the arteries -the effect is limited in time and similar reconstructions require accessory therapy and a closer follow-up (Figure 4). If low flow is observed after infrainguinal reconstructions especially if there is no increase of flow after prostaglandin administration, the reason should be found out and corrected (poor vein, stenosis or improper site of anastomosis, vein twist) to increase the out-flow [33]. Reconstructions that remain with low flow and small alteration of the ratios of amplitudes after medicament vasodilatation have greater risk of failing.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Venous Graft Size and Run-Off Segment for Peripheral Bypass Patency

Jordanov¹

2015

J Vasc Med Surg

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Aim: To analyze the one-year-patency of infrainguinal arterial reconstructions in relation to venous graft diameter and length and the run-off segment, when arteries above the proximal anastomosis of the reconstruction are not diseased.Material and Methods: We compared retrospectively for two-year period the diameter, the length of the used vein and the run-off segment in 107 consecutively constructed infrainguinal autovenous bypasses -54 patent (not less than 1 year) and 53 failed bypasses Diameter of the vein was measured at the narrowest part of the vein (in all cases this was the area of the distal anastomosis). Аll bypassеs are made with translocated nonreversed vein and the length of the vein was measured after the completion of reconstruction. Volume and pressure of blood flow were measured below the distal anastomosis by the means of ultrasound transit-time flowmetry. For the assessment of run-off segment Fourier analyses of flow and pressure were used and alteration of the amplitudes after intragraft infusion of Prostaglandines was calculated.Results: We compared the alteration in amplitudes in failed and patent for at least 1 year bypasses and estimated that ratio below 2 before and after medicamentous vasodilatation, sets the reconstruction in the group of threatened, as well as graft diameter below 3.5 mm and length over 40 cm.Conclusion: Hemodynamic assessment of blood flow below distal anastomosis defines the necessary vein lenght, that is why run-off segment has the most important significance for the patency of the infrainguinal autovenous reconstructions. Shorter grafts with diameter over 3.5 mm do not guarantee longer patency if distal anastomosis is constructed above diseased run-off segment.

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Section: Discussionmentioning

confidence: 99%

Clinical Significance of Venous Graft Size and Run-Off Segment for Peripheral Bypass Patency

Jordanov¹

2015

J Vasc Med Surg

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“…encountered for the operator to find unsatisfying blood flow immediately after declamping the bypass [19]. After ruling out technical problems (e.g.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Pulsatile Index and Diastolic Blood Flow for Popliteal and Tibial Bypass Patency

Cheshmedzhiev¹

2015

J Vasc Med Surg

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Aim: To compare data from pulsatile index [PI) and diastolic blood flow [DF%) after local administration of prostaglandines in failed and patent infrainguinal autovenous bypasses for at least one year, as well as to compare the data obtained from the tibial and the popliteal [above and below knee) bypasses and to estimate its clinical significance for their patency. Patients and Methods: Prospectively for two-year period 107 patients with peripheral arterial occlusive disease, who were subjected to autovenous bypass below the inguinal ligament were included. Intraoperative flowmetry was performed with a VeriQ flowmeter and perivascular probes 'Medi-Stim' at the target artery underneath the distal anastomosis. The measurements were performed after bypass declamping and after intragraft prostaglandin infusion. Results: Intraoperative measurement of blood flow by means of transit time and prostaglandin application was performed in all 107 patients. There were no significant differences between tibial and popliteal bypasses after prostaglandin administration, which to determine their different patency. Patients with early bypass failure had no significant alteration in the estimated values after prostaglandin infusion. Pulsatile index over 2 by specificity 84% and DF% under 51% by specificity 73% after prostaglandins are considered unsatisfying. Conclusion: Prostaglandin application underneath the distal anastomosis results in arterial vasodilatation and is an indicator of the quality of the byass, the anastomoses and runoff arterial capacity. Being dependent on the resistance of the blood outflow, the PI and DF% are important factors for the bypass prognosis but it cannot be calculated as a certain prognostic factor.

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“…In such cases they are a crucial factor for the success of the bypass. 20,21 We decided to explore the use of the fast Fourier transform to assess the infrainguinal arterial reconstruction by using intraoperative fl owmetry under the distal anastomosis. We set out to determine at what change of the MVF and MAP amplitudes we can expect compromising events or long-term patency of the bypass graft comparing the data for the compromised bypasses and the rest of the reconstructions for at least 1 year.…”

Section: Discussionmentioning

confidence: 99%

Fourier Analysis of Peripheral Blood Pressure and Flow in Intraoperative Assessment of Infrainguinal Arterial Reconstructions

Cheshmedzhiev¹,

Mircheva²,

Jordanov³

et al. 2014

Folia Medica

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AIM:To assess infrainguinal arterial reconstructions by intraoperative fl owmetry under the distal anastomosis using a fast Fourier transformation; calculate and compare the amplitude ratios of peripheral arterial blood pressure and volume fl ow before and after drug-induced vasodilation of occluded bypass grafts and bypass grafts that have been patent at least for 1 year. To fi nd what magnitude of the change of these ratios indicate a long-term patency of the bypass grafting. PATIENTS AND METHODS: We compared the results of the intraoperative fl owmetry tests of 97 patients with infrainguinal arterial reconstructions. The patients were divided into two groups based on the graft status: the grafts in 49 patients were patent for at least a year, and 48 patients had failed bypass. We used a fast Fourier transform (FFT) of the pressure and blood fl ow waves and compared the ratios of their amplitudes before and after administration of a vasodilator drug into the graft. Comparing the ratios obtained before and those after administration of the drug we quantifi ed their change in each group and analysed them. RESULTS: After a drug-induced vasodilation, the blood pressure and fl ow amplitude ratios for the group with compromised reconstructions were less than 1.9 times smaller than those before drug infusion, while for the group with bypass grafts that had been functional for at least 12 months the ratios declined by more than 1.9 ≈ 2 times. CONCLUSION: The magnitude of the change of amplitude ratios of the peripheral pressure and volume fl ow after drug-induced vasodilation can be used to make an assessment of the bypass graft and the distal arterial segment. Key words: fast Fourier transform (FFT), distal anastomosis, mean volume fl ow (MVF), mean arterial pressure (MAP), peripheral vascular resistance (PVR)Folia Medica 2014; 56(2): 102-108 Copyright © 2014 Medical University, Plovdiv РЕЗЮМЕ ЦЕЛЬ: Работа ставит себе целью изучить применение быстрой трансформации Фурье в целях оценки инфраингвинальных артериальных реконструкций посредством интраоперативной флоуметрии под дистальным анастомозом, сравнивая результаты отношений амплитуд периферического артериального давления и объема кровотока до и после медикаментозной вазодилатации компрометированных и функционировавших не менее года байпасов, а также определить при каком изменении этих отношений можно предполагать их более продолжительную проходимость. ПАЦИЕНТЫ И МЕТОДЫ: Авторы сравнили данные интраоперативных флоуметрий 97 пациентов с инфраингвинальными артериальными реконструкциями. Пациенты разделены на две группы: первая группа -49 пациентов с функционировавшими не менее года байпасами; вторая группа -48 пациентов с компрометированными. Применена быстрая трансформация Фурье (FFT) давления и кровотока и сравнено отношение их амплитуд до и после инфузии медикамента с вазодилатирующим эффектом посредством имплантата (graft). Сопоставляя результаты отношений до и после применения медикамента, авторы определили количественно их изменение в каждой группе в от...

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

Abstract: Intraoperative measurements of graft flow and resistance do not predict graft outcome at six weeks. However, surveillance does identify at-risk grafts and improves mid-term primary-assisted patency.

Cited by 12 publications

References 24 publications

Clinical Significance of Venous Graft Size and Run-Off Segment for Peripheral Bypass Patency

Clinical Significance of Venous Graft Size and Run-Off Segment for Peripheral Bypass Patency

Clinical Significance of Pulsatile Index and Diastolic Blood Flow for Popliteal and Tibial Bypass Patency

Fourier Analysis of Peripheral Blood Pressure and Flow in Intraoperative Assessment of Infrainguinal Arterial Reconstructions

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