Journal «Angiology and Vascular Surgery» • 

1998 • VOLUME 4 • №1

PROGNOSIS OF THE RESULTS OF FEMORODISTAL "IN SITU" VEIN BYPASS GRAFTING BY VOLUME BLOOD FLOW VELOCITY ASSESSMENT

A.V. Gavrilenko, V.A. Sandrikov, S.I. Skrylev, A.N. Kosenkov, V.I. Sadovnikov, V.V. Dzhabbarov
Department of Peripheral Vascular Surgery,
Department of Clinical Physiology and Functional Diagnosis,
Scientific Centre of Surgery, Russian Academy of Medical Sciences,
Moscow, Russia

The purpose of the study was to establish criteria for intraoperative evaluation of the adequacy ofthefemo-rodistalin situ vein bypass grafting. 47 patients (12 women and 35 men) were included/or the study. The patients 'age ranged from 46 to 69 years (mean 55.0±4.5 years). The causes of vascular diseases were atherosclerosis recognised in 40 (85.1%) patients and thrombangiitis obliter-ans identified in 7 (14.9%) patients. Coexistent diabetes mellitus was revealed in 11 (23.4%) patients. Of these, 6 patients had type land 5 patients type II diabetes mellitus. Coronary artery disease (42.5%) and arterial hypertension (21.3%) prevailed among other coexistent diseases. The severity of chronic ischemia of the lower limbs was evaluated according to the R. Fontaine classification. 8 (17%) patients had stage II, 22 (46.8%) stage III, and 17 (36.2%) patients had stage IV chronic ischemia of the lower limbs. All the patients suffering from diabetes mellitus had stage III and stage IV chronic ischemia of the lower limbs (4 and 7 cases, respectively). Depending on the patency of the distal bed all the patients were divided into three groups. The first group comprised 14 (29.8%) patients, in whom all three arteries of the calf (aa. tibialis anterior et posterior, a.peronea) were patent, the second group included 20 (42.6%) patients with occlusion of one of the tibial arteries, and the third group included 13 (27.6%) patients with occlusion of two tibial arteries. To evaluate the adequacy of the operation performed, intraoperative measurements were made of the volume blood flow velocity in the graft. Results: The values of the volume blood flow velocity in the graft ranged within 55 to 320 ml/min and were dependent on the condition of the peripheral vascular bed. In the first group, the volume blood flow ve locity was 210±25.5, in the second group, it constituted 165±20.0, and in the third group, it was equal to 115±18.0 ml/min. It has been established that ligation of the collaterals entails a 25-30% increase in the volume blood flow velocity in the area of the distal anastomoses. The functioning of the femorodistal in situ grafts was followed up in 41 patients over the period as long as one year. The cumulative patency of the vein grafts amounted to 82.9%. Thrombosis was identified in 3 patients of the second group and in 4 patients of the third group (17.1% altogether). The volume blood flow velocity in all these patients appeared to be less than 100 ml/min. Conclusion: Intraoperative flowmetry allows the results of femorodistal in situ vein bypasses to be predicted. Consequently, provided the volume blood flow velocity constitutes less than 100 ml/min, it is necessary to change the surgical policy in order to prevent graft throw -bosis in the early postoperative period.

P. 95-102

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