Significance and management of inflow gradients unexpectedly generated after femorofemoral, femoropopliteal, and femoroinfrapopliteal bypass grafting.
With multilevel arteriosclerosis, some patients undergoing infrainguinal bypass grafting will develop femoral/brachial pressure gradients only after the bypass is performed. We therefore evaluated arteriographically alternate inflow sites and measured the femoral/brachial pressure gradients before and after placement of 87 femorofemoral and 510 femoropopliteal/infrapopliteal bypasses. No prebypass femoral/brachial pressure gradients were present with and without intraarterial papaverine. However, femoral/branchial pressure gradients greater than or equal to 15 mm Hg were observed after the bypass placement in 16 femorofemoral patients and 43 femoropopliteal/infrapopliteal patients. Gradients averaged 28 +/- 8 (SD) (range, 15 to 50) mm Hg. The post femorofemoral bypass gradients were treated by immediate supplementary inflow extension to the aorta (three patients) or an axillary artery (three patients); by postoperative iliac percutaneous transluminal angioplasty (four patients) or by no treatment (six patients with femoral/brachial pressure gradients of 15 to 35 [23 +/- 5] mm Hg). The 43 postfemoropopliteal/infrapopliteal bypass gradients were treated by immediate supplementary inflow extension to the contralateral femoral artery (15 patients), the aorta (8 patients), or an axillary artery (3 patients); by postoperative iliac percutaneous transluminal angioplasty (5 patients) or by no treatment (12 patients with femoral/brachial pressure gradients of 15 to 30 [21 +/- 4] mm Hg). No thrombosis occurred in the 10 femorofemoral bypasses with postbypass femoral/brachial pressure gradients that were treated. One of the six femorofemoral patients with untreated gradients required a subsequent aortic extension, and one thrombosed after 2 years. Of the 12 untreated patients with femoropopliteal/infrapopliteal bypasses one graft occluded early, and two late failures occurred 12 and 18 months later.(ABSTRACT TRUNCATED AT 250 WORDS)
Gupta
S K
SK
Division of Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY 10467.
Veith
F J
FJ
Kram
H B
HB
Wengerter
K A
KA
D000368:Aged; D001161:Arteriosclerosis / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D001807:Blood Vessel Prosthesis; D003251:Constriction, Pathologic / Q000175:diagnosis; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery; D007866:Leg / Q000098:blood supply*; D010208:Papaverine; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012039:Regional Blood Flow; D014654:Vascular Patency
D010208:Papaverine