The influence of patent branches on in situ vein graft haemodynamics.
The effect of patent graft branches on intra-operative graft flow and pressure has been studied in 50 patients undergoing in situ vein femoro-distal arterial bypass. In 35 grafts in which patent branches in the calf and thigh were preserved as arteriovenous fistulae, release of temporary branch occlusion increased mean proximal graft flow by 178.6% in 32, and reduced distal graft flow by 49.7% in 30. Seventeen limbs had thigh fistulae only: release of temporary fistula occlusion produced a fall in distal graft flow in only three. We identified three types of fistula: (a) cutaneous branches usually found in the thigh, which do not affect graft flow; (b) perforator branches which increase graft inflow but have no effect on distal graft flow: (c) perforator branches which increase graft inflow and decrease graft outflow, and are most frequently found in the calf. Discrimination between these haemodynamically differing branches at operation proved difficult. Since patent branches never improve distal graft flow and may reduce it, we recommend that all fistulae are ligated at operation.
Gwynn
B R
BR
Department of Vascular Surgery, Selly Oak Hospital, Birmingham, U.K.
Shearman
C P
CP
Simms
M H
MH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000503:physiopathology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical; D003097:Collateral Circulation; D005260:Female; D005263:Femoral Artery / Q000502:physiology* / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000502:physiology* / Q000601:surgery; D014463:Ultrasonography; D014654:Vascular Patency