Pressure traps in femoro-popliteal reversed vein grafts. Are valves culprits?
BACKGROUND
Stenosis is a major cause of vein graft failure in peripheral arterial surgery. Our goal is to determine whether vein valves play a role in this process by creating a "pressure trap".


METHODS
Seventeen patients with femoro-popliteal reversed saphenous vein grafts were studied intraoperatively. Flow and pressure in the grafts were measured, while the graft outflow was gradually occluded and released for 2-4 seconds. In 3 patients the graft flow was reduced by compressing calf muscles.


RESULTS
Patients heart rates were 54-84 BPM, blood pressures 170/80-110/55 mm Hg, and normal graft flow was 40-180 ml/min. In 12 patients with competent vein valves, at reduced flow (<30 m/min) the valves opened and closed in each cardiac cycle. At each closure the pressure was "trapped" distal to the valve producing diastolic hypertension. Also the flow was stagnant for a considerable portion of the cardiac cycle. Maximum diastolic pressure gradient across the valve ranged from 35 to 60 mm Hg and the level of pressure trapped was inversely proportional to the graft flow.


CONCLUSIONS
In patients in whom reversed vein grafts with competent valves are placed in the femoro-popliteal positions a "pressure-trap" develops in the distal segment. This segmental hypertension combined with the flow stagnation could play an important role in the graft thickening and stenosis.
Robicsek
F
F
Heineman Medical Research Laboratory, Charlotte, North Carolina 28203, USA.
Thubrikar
M J
MJ
Fokin
A
A
Tripp
H F
HF
Fowler
B
B
D000714:Anastomosis, Surgical; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001783:Blood Flow Velocity; D001794:Blood Pressure; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D011150:Popliteal Artery / Q000601:surgery*; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*