Study of Peripheral Flow During Successful Aortoiliac and Aortofemoral Prosthetic Reconstructions by Intraoperative Above-Ankle Pressure Index Monitoring

Abstract

Doppler above-ankle pressure index (API) was monitored during 368 consecutive bilateral aortoiliac or aortofemoral graft reconstructions performed for aneurysmal or occlusive disease. The aim of this study was to investigate the variations of peripheral pressure, during and just after completion of the procedure, either when followed by immediate and definitive success or when an intraoperative correction or an early postoperative reoperation was necessary owing to postreconstructive ischemia. For this purpose the API courses were subdivided into three groups: A (705 limbs), which underwent immediately successful reconstructions; B (22 limbs), which needed intraoperative correction; C (9 limbs), which required early reoperation. All 736 limbs were studied individually as monolateral reconstructions and classified into six subgroups: 1, pervious iliac, pervious femoral artery; 2, occluded iliac, pervious femoral; 3, pervious iliac, stenotic femoral (i.e, stenosis > 75% of the superficial femoral artery); 4, occluded iliac, stenotic femoral; 5, pervious iliac, occluded femoral; 6, occluded iliac, occluded femoral. APIs were monitored before the operation at NATIONAL TAIWAN UNIV LIB on June 29, 2015 ves.sagepub.com Downloaded from 308 (PRE), at the completion of the distal anastomosis (DEC), and five, fifteen, thirty, and forty-five minutes after. Data were statistically analyzed by multivariate analysis in regards to 705 immediately successful limbs (group A) and by comparison of all corrected or reoperated cases (groups B and C) with the lower bound of the fifth centiles of group A.The results in group A show that: API-PRE is different in the six subgroups (p < 0.001); API-DEC is lower than API-PRE in the patent iliac artery subgroups (1,3, and 5) and higher than API-PRE in the occluded iliac artery subgroups (2,4, and 6) (p always < 0.001). From declamping time to the forty-fiveminutes observation, the mean courses turn out parallel and rising but on different levels (p < 0.001): pervious femoral, stenotic femoral, occluded femoral. API-forty-five minutes is higher than API-PRE in occluded iliac artery subgroups (2, 4, and 6) (p < 0.001), whereas in the patent iliac artery subgroups only the fifth subgroups reveals a slight but significant rise (p < 0.01), probably owing to the high rate of profunda femoral endarterectomy or angioplasty associated with aortofemoral reconstructions.APIs values of 31 cases in groups B and C, compared with the lower bound of the fifth centile of group A, show that 8/31 cases (26%) remain above that bound, while 23/31 cases (74%) fall below it.

Arterial baroreflex sensitivity and blood pressure variabilities before and after carotid surgery

“…No characteristic blood pressure changes have been described, even when measuring much more sensitive circulatory parameters [8,14,15,17,22,23].…”