Journal de médecine vasculaire et de chirurgie

Abstrait

Clinical Significance of Pulsatile Index and Diastolic Blood Flow for Popliteal and Tibial Bypass Patency

Mihail Cheshmedzhiev, Krasimir Ivanov, Iskra Mircheva and Emil Jordanov

Aim: To compare data from pulsatile index [PI) and diastolic blood flow [DF%) after local administration of prostaglandines in failed and patent infrainguinal autovenous bypasses for at least one year, as well as to compare the data obtained from the tibial and the popliteal [above and below knee) bypasses and to estimate its clinical significance for their patency.

Patients and Methods: Prospectively for two-year period 107 patients with peripheral arterial occlusive disease, who were subjected to autovenous bypass below the inguinal ligament were included. Intraoperative flowmetry was performed with a VeriQ flowmeter and perivascular probes ‘Medi-Stim’ at the target artery underneath the distal anastomosis. The measurements were performed after bypass declamping and after intragraft prostaglandin infusion.

Results: Intraoperative measurement of blood flow by means of transit time and prostaglandin application was performed in all 107 patients. There were no significant differences between tibial and popliteal bypasses after prostaglandin administration, which to determine their different patency. Patients with early bypass failure had no significant alteration in the estimated values after prostaglandin infusion. Pulsatile index over 2 by specificity 84% and DF% under 51% by specificity 73% after prostaglandins are considered unsatisfying.

Conclusion: Prostaglandin application underneath the distal anastomosis results in arterial vasodilatation and is an indicator of the quality of the byass, the anastomoses and run-off arterial capacity. Being dependent on the resistance of the blood outflow, the PI and DF% are important factors for the bypass prognosis but it cannot be calculated as a certain prognostic factor.