The role of peripheral vascular resistance in determining the infrainguinal arterial reconstruction patency

Cheshmedzhiev, Mihail V.; Knyazhev, V.; R, Radev; Yordanov, Emil

doi:10.2478/v10153-011-0067-9

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Our study confirmed that poor circulation negatively influences the results of both operative and endovascular revascularization. [18][19][20] Another important clinical observation is that when reocclusion occurs in the presence of significant tibial vessel disease, the extent of the thrombus is increased and often precludes any revascularization. Therefore, in our opinion, the presence of poor circulation in patients with ALI warrants aggressive treatment to improve outflow.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of accelerated catheter-directed thrombolysis in patients with acute arterial thrombosis

Łukasiewicz

Lichota²,

Thews³

2016

Vasc Med

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Current intra-arterial catheter-directed thrombolysis (CDT) protocols recommend treatment with small doses of a thrombolytic agent, which excludes patients in need of urgent revascularization. We evaluated the effects of accelerated thrombolysis utilizing increased recombinant tissue plasminogen activator (rt-PA) doses. Forty-one patients with acute, thrombotic limb ischemia (ALI) were treated using accelerated CDT. The treatment consisted of an initial dose of 10 mg rt-PA for 30 minutes followed by a 3-hour course of a continuous intra-arterial 10 mg/hour rt-PA infusion. Simultaneously, intravenous unfractionated heparin (500 IU/hour) was administered. No deaths occurred. Satisfactory lysis was achieved in 37 of the 41 patients (90.2%). All significant underlying lesions were corrected (89.2%). Complications developed in nine patients (22%); the most frequent complication (four patients, 9.8%) was puncture site hematoma. The reintervention rate was 2.6% and 15.4% at the 1 and 6-month follow-ups, respectively. The major amputation rate was 10.3% and 12.8% at the 1 and 6-month follow-ups, respectively. Outflow compromise was adversely related to successful outcome at the 6-month follow-up (p=0.01). In conclusion, this study confirms the effectiveness and safety of the accelerated CDT regimen for treatment of thrombotic ALI at a single center, but requires confirmation in further studies.

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Section: Discussionmentioning

confidence: 99%

Outcomes of accelerated catheter-directed thrombolysis in patients with acute arterial thrombosis

Łukasiewicz

Lichota²,

Thews³

2016

Vasc Med

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“…Significant efforts are made in intraoperative assessment of results of revascularization procedures. Angiography, measurement of averaged flow, wave form [1][2][3], flow velocity [4,5], resistance [6][7][8][9][10] and impedance [11,12] were used.…”

Section: Introductionmentioning

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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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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The role of peripheral vascular resistance in determining the infrainguinal arterial reconstruction patency

Cited by 3 publications

References 18 publications

Outcomes of accelerated catheter-directed thrombolysis in patients with acute arterial thrombosis

Outcomes of accelerated catheter-directed thrombolysis in patients with acute arterial thrombosis

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

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

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