Intraoperative flow measurement of distal runoff: a valid predictor of outcome of infrainguinal bypass surgery.
OBJECTIVE
To assess the power of operative flow measurements in the prediction of outcome after infrainguinal bypass operations for critical ischaemia


METHODS
Open study


METHODS
University department of vascular surgery


METHODS
197 patients operated on for critical ischaemia between 1 January 1982 and 31 December 1989 under the care of one surgeon.


METHODS
Standard operative angiography and measurement of flow of distal runoff


METHODS
Patency and limb salvage


RESULTS
All patients were followed up prospectively until 31 March 1991 or death. The estimated 5 year rates of primary patency and limb salvage were 0.75 and 0.86, respectively. Multivariate analysis showed that flow measurement was the most powerful predictor of graft patency (p = 0.0003) and limb salvage (p = 0.004) of all factors studied, including angiography. Irrespective of the site of distal anastomosis no polytetrafluoroethylene (PTFE) graft remained patent if the flow was less than 50 m/minute, whereas vein grafts remained patent if the flow was as little as 10 ml/minute.


CONCLUSIONS
Flow is easy to measure and is a better predictor of outcome than angiography. Decisions about grafting should rely on flow measurements if there is any doubt about patency or limb salvage, particularly if a PTFE graft is going to be used.
Stirnemann
P
P
Department of Thoracic and Cardiovascular Surgery, University of Berne, Switzerland.
Ris
H B
HB
Do
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D
Hämmerli
R
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D000368:Aged; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency