Flow measurement before and after papaverine injection in above-knee prosthetic femoropopliteal bypass.
OBJECTIVE
To investigate the value of intraoperative blood flow measurements on early and long-term patency of above-knee prosthetic femoropopliteal bypass.


METHODS
Flow was measured with a transit time flowmeter before (basal flow) and after an intragraft injection of papaverine (papaverine flow) in 87 operations (86 patients) between January 1990 and December 2001. Sixty-one grafts were of polyester, and 26 were of polytetrafluoroethylene. The operations were done under epidural anesthesia. The preoperative angiographic run-off score and clinical risk factors were recorded. Patency rates were analyzed with the product limit method and compared with the log-rank test. Variables found to be near significantly related to patency rates (P < .1) were included in a multivariate analysis performed with the Cox proportional hazard model.


RESULTS
Basal flow measurements were not related to patency. The 2- and 5-year patency rates for grafts with a papaverine flow < or = 500 mL/min were 48% and 18% compared with 66% and 52% for grafts with a papaverine flow > or = 500 mL/min. These differences were statistically significant (P = .012, hazard ratio, 2.6). Two- and 5-year patency rates for smokers vs nonsmokers were 44% and 18% vs 69% and 54%. The patency rates for patients with poor vs good run-off were 42% and 27% vs 66% and 31%. Smoking (P = .008, hazard ratio, 2.75) and poor run-off score (P = .009, hazard ratio, 2.38) were found to be independent risk factors for reduced patency rates. Poor run-off score did not correlate with low values of measured basal or papaverine flow.


CONCLUSIONS
Papaverine flow of < or = 500 mL/min is associated with reduced mid- and long-term patency rates. Additional antithrombotic medication and frequent follow-up for these grafts should be considered. The inferior patency rates of smokers and patients with poor run-off indicate that prosthetic bypass is less suitable for these groups of patients.
Pedersen
Gustav
G
Department of Surgery, Haukeland University Hospital, Bergen, Norway. gustav.pedersen@helse-bergen.no
Laxdal
Elin
E
Amundsen
Svein Roar
SR
Dregelid
Einar
E
Jonung
Torbjørn
T
Nyheim
Thomas
T
Aune
Steinar
S
D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001783:Blood Flow Velocity / Q000502:physiology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D016343:Monitoring, Intraoperative; D010208:Papaverine / Q000627:therapeutic use*; D011150:Popliteal Artery / Q000601:surgery*; D011336:Probability; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects
D010208:Papaverine