Sage Journals: Discover world-class research

Abstract

The quality of distal run-off is one of the most important factors in determining outcome of femorodistal bypass. Accurate evaluation is important. Preoperative intra-arterial digital subtraction angiography and Doppler evaluation with pulse-generated augmentation of 90 patients who underwent femorodistal reconstruction were compared with postoperative angiography. Underestimation of distal run-off of the calf vessels occurred in 33% of cases by preoperative intra-arterial digital subtraction angiography. A below-knee pulse-generated run-off score of 3 or less was associated with a 12-month cumulative patency of 73% compared with 85% with a below-knee pulse-generated run-off score of 4 or more (P= 0.079, log rank test; P= 0.060, Wilcoxon signed rank test). The 12-month cumulative patency for grafts with a complete, incomplete and occluded arch as defined by pulse-generated run-off was 78.90 and 38% respectively (P< 0.0001 log rank and Wilcoxon signed rank tests). Preoperative evaluation of distal run-off before femorodistal bypass should not be based exclusively on intra-arterial digital subtraction angiography.

Keywords

run-off Doppler angiography

Get full access to this article

View all access options for this article.

References

Brewster

La Salle

Robison

Strayhorn

Darling

. Factors affecting the patency of femoro-popliteal bypass grafts. Surg Gynecol Obstet 1983; 157: 437–42.

Parvin

Evans

Bell

PRF

. Peripheral resistance measurements of severe peripheral vascular disease. Br J Surg 1985; 72. 751–3.

Peterkin

Manabe

LaMorte

Menzoian

. Evaluation of a proposed standard reporting system for preoperative angiograms in infrainguinal bypass procedures: Angiographic correlates of measured runoff resistance. J Vasc Surg 1988; 7: 379–85.

Rutherford

Jones

Bergentz

S-E

. Factors affecting the patency of infrainguinal bypass. J Vasc Surg 1988; 8: 236–46.

Yao

. Haemodynamic studies in peripheral arterial disease. Br J Surg 1970; 57: 761–6.

Shearman

Gwyn

Curran

Gannon

Simms

. Non-invasive femoro-popliteal assessment: Is that arteriogram really necessary? BMJ 1986; 193: 1086–9.

Simms

. Pedal arch patency in successful reconstruction. In: Greenhalgh

Jamieson

Nicolaides

, eds. Limb Salvage and Amputation for Vascular Disease. London: Saunders, 1988: 49–62.

Brennan

Hartshore

Beard

Bell

PRF

. Doppler ultrasonographic assessment of the severely ischaemic limb: A comparison of three different methods. Br J Surg 1992; 79: 360.

Beard

Scott

DJA

Evans

Skidmore

Horrocks

. Pulse generated run-off (PGR): A new method of assessing calf vessel patency. Br J Surg 1988; 75: 361–3.

10.

Scott

DJA

Vowden

Beard

Horrocks

. Non-invasive estimation of peripheral resistance using pulse generated runoff before femorodistal bypass. Br J Surg 1990; 77: 391–5.

11.

Scott

DJA

Hunt

Beard

Hartnell

Horrocks

. Arteriogram scoring systems and pulse generated run-off in the assessment of patients with critical ischaemia for femorodistal bypass. Br J Surg 1989; 76: 1202–6.

12.

Thompson

Sayers

Beard

Hartshorne

Brennan

Bell

PRF

. The role of pulse-generated run-off, Doppler ultrasound and conventional arteriography in the assessment of patients prior to femorocrural bypass grafting. Eur J Vasc Surg 1993; 7: 37–40.

13.

Menzoian

LaMorte

Cantelmo

. The preoperative angiogram as a predictor of peripheral run-off. Am J Surg 1985; 150: 346–52.

14.

Sumner

Porter

Moore

Winders

. Digital subtraction angiography: Intravenous and intra-arterial techniques. J Vasc Surg 1985; 2: 344–53.

15.

Dardik

Miller

Adler

. Primary and adjunctive intra-arterial digital subtraction arteriography of the lower extremities. J Vasc Surg 1986; 3: 599–63.

16.

Gyftokostas

Ranaboldo

Birch

Davies

Chant

ADB

. Pulse generated runoff, validation using digital subtraction arteriography. Br J Surg 1992; 79: 360.

17.

Sikovejc

Davies

Baird

. Evaluation of the distal run-off for femorodistal bypass. Cardiovacular Surgery 1993; 1: 619–23.

18.

Roedersheimer

Feins

Green

. Doppler evaluation of the pedal arch. Am J Surg 1981; 142: 601–4.

19.

Klimach

Charlesworth

. Femorotibial bypass for limb salvage using human umbilical vein. Br J Surg 1983; 70: 1–3.

20.

O'Mara

Flinn

Neiman

. Correlation of foot arterial anatomy with early tibial bypass patency. Surgery 1981; 89: 743–52.

21.

Scarpato

Gembarowicz

Farber

. Intra-operative pre-reconstruction arteriography. Arch Surg 1981; 116: 1053–5.

22.

Flanigan

Williams

Keifer

. Pe-bypass operative arteriography. Surgery 1982; 92: 627–33.

23.

Campbell

Fletcher

Hands

. Assessment of the distal lower limb arteries: A comparison of arteriography and Doppler ultrasound. Ann R Coll Surg Engl 1986; 68: 37–9.

24.

Patel

Semel

Clauss

. Extended reconstruction rate for limb salvage with intraoperative prereconstruction angiography. J Vasc Surg 1988; 7: 531–7.

25.

Feins

Roedersheimer

Baumstark

Green

. Predicted hyperemic angiography: A technique of distal arteriography of the severely ischaemic limb. Surgery 1981; 89: 202–5.

26.

Jacobs

Hanafee

. The use of prisoline in peripheral arteriography. Radiology 1967; 88: 957–60.

27.

Karacagil

Almgren

Bergstrom

Bowald

Eriksson

. Postoperative predictive value of a new method of intraoperative angiographic assessment of runoff in femoropopliteal bypass grafting. J Vasc Surg 1989; 10: 400–7.

28.

Karacagil

Almgren

Bowald

Eriksson

. Angiographic criteria for prediction of early failure of secondary infrainguinal bypass surgery. J Vasc Surg 1990; 12: 131–8.

Evaluation of Distal Run-off before Femorodistal Bypass

Abstract

Keywords

Get full access to this article

References