The preoperative angiogram as a predictor of peripheral vascular runoff

Menzoı́an, James O.; Morte, Wayne W. La; Cantelmo, Nancy L.; Doyle, Jeanne E.; Sidawy, Anton N.; Savenor, Arnold

doi:10.1016/0002-9610(85)90076-5

Cited by 20 publications

(6 citation statements)

References 17 publications

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“…In a previous study we established that vein graft PSFV was inversely correlated to vein graft diameter for tibial (r = -0.49, p = 0.005) and popliteal (r = -0.73, P = 0.002) outflow grafts. 9 We also found significantly lower PSFVs in extremely distal tibial and pedal outflow grafts (59.1 ± 3.4 cm/sec) than more proximal tibial (77.2 ± 5.6 cm/sec) and popliteal bypass grafts (71.0 ± 5.6 cm/sec, p = 0.04). We hypothesized that a more complete understanding of the factors influencing individual vein graft hemodynamics would allow more accurate identification of grafts that have abnormal hemodynamics and thus harbor significant abnormalities.…”

Section: Discussionsupporting

confidence: 55%

See 1 more Smart Citation

A prospective study of the determinants of vein graft flow velocity: Implications for graft surveillance

Belkin¹,

Raftery²,

Mackey³

et al. 1994

Journal of Vascular Surgery

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Serial monitoring of vein graft peak systolic flow velocity (PSFV) has been endorsed as a technique for vein graft surveillance with low values « 45 cm/sec) considered a marker for impending graft failure. Optimal application of this method requires an understanding of the factors affecting PSFV in normal grafts. A prospective evaluation of 46 consecutive elective infrainguinal vein grafts (6 popliteal/29 tibial/ll pedal) was undertaken to assess the major determinants of PSFV. Methods: Factors recorded for each patient included vein graft diameter (VGD), measured outflow resistance (MOR), conduit length, outflow level (popliteal/tibial/pedal), inflow level (femoral/popliteal), systolic blood pressure, cardiac ejection fraction, the presence of a patent plantar arch, and Society for Vascular Surgery/International Society for Cardiovascular Surgery resistance scoring. MOR was measured by occluding graft inflow and infusing saline solution through a proximal graft cannula at 60 cc/min while simultaneously recording the pressure at the distal anastomosis via a separate cannula. MOR was calculated by dividing the resultant pressure by the infusion rate. MORs were expressed in resistance units and were measured before and after the infusion of papaverine (MOR(PAP». PSFVs and VGDs were measured 4 to 6 cm from the distal anastomosis 3 weeks after surgery with duplex scanning (60 degree angle with midstream sample volume). Results: PSFVs ranged from 22 to 148 cm/sec and averaged 83.4 ± 4.8 cm/sec. Pedal bypass grafts had significantly lower PSFVs (64 ± 10 vs 89.5 ± 5 cm/sec,p = 0.02) and significantly higher MOR(PAP)s (0.86 ± 0.15 vs 0.51 ± 0.05 resistance units,p = 0.05) ,than bypasses to the popliteal/tibial level. When subjected to univariate analysis the factors correlating with PSFV were MOR (r = -0.59, P = 0.0001), MOR(PAP) (r = -0.69, P = 0.0001) VGD (r = -0.31,p = 0.06), the Society for Vascular Surgery/International SocietyforCardiovascularSurgeryscore(r = -0.35,p = 0.04),inflowlevel(r = -0.47, P = 0.002), and outflow level (r = -0.35,p = 0.03). When subjected to multiple regression analysis, only MOR(PAP) (,-2 = 0.51, P = 0.001) and VGD (,-2 = 0.14, P = 0.001) contributed significantly to the overall model (,-2 = 0.65, P = 0.0001) with MOR(PAP» eliminating the effect of the other variables. The multiple regression model predicts PSFVas follows: PSFV = 176 + VGD(rmn)( -11.7) + MOR(PAP»( -63.4).Conclusions: Clinically successful and hemodynamically normal vein grafts have widely variable, yet predictable flow characteristics that are influenced primarily by outflow resistance and VGD. This wide variability suggests that no single lower threshold value for PSFV is universally applicable in identifying all grafts at risk for failure. Detection of focal areas of flow acceleration within the graft may be more accurate in identifying grafts at risk for failure. (

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Section: Discussionsupporting

confidence: 55%

“…Mter confirmation of a technically satisfactory result, outflow resistances were measured by a modification of the technique developed by Menzoian et a1. 9 As shown in Fig. 1, the proximal graft cannula was connected to a Medrad Mark II arteriographic injector (Medrad, Inc., Pittsburgh, Pa.).…”

Section: Methodsmentioning

confidence: 99%

A prospective study of the determinants of vein graft flow velocity: Implications for graft surveillance

Belkin¹,

Raftery²,

Mackey³

et al. 1994

Journal of Vascular Surgery

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“…LaMorte et al also found that in femoropopliteal arterial reconstructions, the pedal arch had a greater impact on resistance than the calf arteries did, determined by assessing the correlation of preoperative arteriographic runoff with vascular resistance measured at the time of surgery 6 The shortcomings of arteriographic runoff classifications remain the subjective judgment of individual surgeons. Menzoian et al made use of four readers scoring the same arteriogram and only one could assign a proper score in terms of vascular resistance measured at surgery.3 3 With the scoring method, it is impossible to take into account gradations in vessel quality. In the present study, the peroneal artery, as shown in Group A of our arteriographic classificatioon, did not contribute to vascular runoff under good conditions of runoff.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1990

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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.

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“…Non-invasive vascular investigations were not performed routinely but preoperative digital substraction angiography was carried out in all patients [23,24,32]. All patients had a routine preoperative check-up, most of them belonged to a high risk group due to previous cardiac problems and sequelae of diabetes and in situ 8 non-reversed, non in-situ 1 reversed 4 donor cryopreserved 2 donor fresh 1 PTFE femoropopliteal bypass 4 dilatation 2 lumbar symphatectomy 2 patch angioplasty 2 bifurcation prosthesis 1 atherosclerosis.…”

Section: Methodsmentioning

confidence: 99%

Single-stage revascularization and free flap coverage in the treatment of ischemic lower limb lesions

et al. 1996

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Old age, diabetes and atherosclerotic disease all have been considered to be relative contraindications for microsurgery. As such, gangrenous lesions of the lower limb traditionally resulted in staged amputations. A more aggressive approach, combining revascularization and free tissue transfer, allowed us to limit the level of amputation and to start early ambulation and rehabilitation, without the need for major orthotic help. Performing the vascular procedure, debridement, and free tissue transfer in one single intervention greatly reduces the number of operative procedures without substantial increase in operative time. Twenty consecutive patients underwent a combined free flap and revascularization procedure, two patients died perioperatively. One free flap was lost and needed replacement. All surviving patients were ambulating postoperatively.

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The preoperative angiogram as a predictor of peripheral vascular runoff

Cited by 20 publications

References 17 publications

A prospective study of the determinants of vein graft flow velocity: Implications for graft surveillance

A prospective study of the determinants of vein graft flow velocity: Implications for graft surveillance

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

Single-stage revascularization and free flap coverage in the treatment of ischemic lower limb lesions

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