title: The fate of femoropopliteal and femorodistal bypass grafts in relation to intraoperative flow measurement: an analysis of 100 consecutive reconstructions for limb salvage.
abstract: Adequacy of outflow is the key determinant for success in peripheral arterial reconstructions. In an attempt to obtain reliable information on this parameter, we developed a new concept: the outflow through the recipient arterial bed is measured perioperatively. For this purpose, the recipient artery is cannulated and perfused with a saline solution from an open reservoir for 1 minute with a pressure of 120 cm H2O. In a prospective study, the outcome of 100 femoropopliteal and femorodistal bypass procedures, all performed for unremitting rest pain, nonhealing ischemic ulcers, or gangrenous tissue loss, is analyzed according to this 1-minute flow rate. Six grafts occluded, and major amputations were unavoidable in three additional patients despite an open bypass. Eight of these crucial events occurred in the group with a flow rate less than 50 ml/min. Two of four Gore-Tex grafts in the low flow category failed within the first postoperative month. In contrast, only one of 24 vein bypasses occluded within the same observation period. All patients having a postoperative flow exceeding 100 ml/min had open grafts in the 2-year observation period. It is concluded that although a diminished outflow rate of less than 50 ml/min represents a high risk failure of reconstructive vascular surgery, attempting a femorodistal bypass is still justified, especially if a vein of adequate size and quality is available as a graft substitute. However, the implantation of a prothetic bypass conduit to a single tibial vessel should be performed only in selected patients.
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001161:Arteriosclerosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D007866:Leg / Q000098:blood supply / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*