Significance of Arterial Defects on Completion Arteriograms Following Infrainguinal Bypasses

Abstract

Intraluminal filling defects of the runoff arteries, which were transient in most cases, are frequently observed on completion arteriograms after crural arterial reconstructive proce dures. However, the incidence, fate, and significance of these changes have yet to be clarified. Completion arteriograms of 108 bypasses were evaluated retrospectively. The incidence of intraluminal defects of runoff arteries was examined by measuring the internal diameter on completion arteriograms and its relationship to the distal anasto motic site, underlying disease, and time the artery was ischemic, and the results of intra operative magnetic flowmetry were analyzed. These changes were compared with those revealed by subsequent postoperative arteriography. The incidence of arterial defects was 46% (50/108) and was higher in bypasses to more distal arteries (P<0.0001) and Buerger's disease patients (P<0.0001). Ninety percent (45/50) were transient. Postreconstructive flowmetry reflected the severity of intraluminal defects of runoff arteries; however, the fates of these changes could not be predicted by use of completion arteriography or intraoperative magnetic flowmetry.

Get full access to this article

View all access options for this article.

References

Mills RM , Taylor SM : Contribution of routine intraoperative completion arteriography to early infrainguinal bypass patency. Am J Surg 164:506-511, 1992.

Samson RH , Gupta SK , Scher LA , et al: Arterial spasm complicating distal vascular bypass procedures . Arch Surg 117:973-975, 1982.

Sasajima T. , Kubo Y. , Izumi Y. , et al: Plantar or dorsalis pedis artery bypass in Buerger's disease . Ann Vasc Surg 8:248-257, 1994.

Rutherford RB , Flanigan DP , Gupta SK , et al: Suggested standards for reports dealing with lower extremity ischemia. J Vasc Surg 20:80-94, 1986.

Shindo S. , Tada Y. , Sato O. , et al: Esmarch's bandage technique in distal bypass surgery. J Cardiovasc Surg 33:609-612, 1992.

Johnston Cdr : Operative angiography for femoropopliteal vein bypass reconstruction. Am J Surg 126:120-121, 1973.

Nunez AA , Hutson DG : Side branch completion arteriography. Surg Gynecol Obstet 168:538-541, 1989.

Plecha FR , Pories WJ : Intraoperative angiography in the immediate assessment of arterial reconstruction . Arch Surg 105:902-907, 1972.

Dardik II , Ibrahim IM , Sprayregen S. , et al: Routine intraoperative angiography. An essential adjunct in vascular surgery. Arch Surg 110:184-190, 1975.

10.

Dardik H. , Ibrahim IM , Koslow A. , et al: Evaluation of intraoperative arteriography as a routine for vascular reconstructions. Surg Gynecol Obstet 147:853-858, 1978.

11.

Martin ML , Veith FJ , Panetta TF , et al: A new look at intraoperative completion arteriography: Classification and management strategies for intraluminal defects. Am J Surg 166:136-140, 1993.

12.

Chalmers Rta , Synn AY , Hoballah JJ , et al: Is the use of intraoperative post-reconstruction angiography following in situ saphenous vein bypass redundant? Am J Surg 166:141-145, 1993.

13.

Barnes JM , Trueta J. : Arterial spasm. An experimental study. Br J Surg 30:74-79, 1942.

14.

Owada A. , Saito H. , Nagai T. , et al: Prophylactic use of intravenous prostaglandin E1 for radial arterial spasm in uremic patients undergoing construction of arteriovenous hemodialysis fistulas. Int J Artif Organs 17:511-514, 1994.

15.

Gilbertson JJ , Walsh DB , Zwolak RM , et al: A blinded comparison of angiography, angioscopy, and duplex scanning in the intraoperative evaluation of in situ saphenous vein bypass grafts. J Vasc Surg 15:121-129, 1992.

16.

Miller A. , Marcaccio EJ , Tannenbaum GA , et al: Comparison of angioscopy and angiography for monitoring infrainguinal bypass vein grafts: Results of a prospective randomized trial. J Vasc Surg 17:382-398, 1993.

17.

Harward Trs , Govostis DM , Rosenthal GJ , et al: Impact of angioscopy on infrainguinal graft patency. Am J Surg 168:107-110, 1994.

18.

Sladen JG , Reid JD , Cooperberg PL , et al: Color flow duplex screening of infrainguinal grafts combining low and high velocity criteria. Am J Surg 158:107-112, 1989.

19.

Bandyk DF , Mills JL , Gahtan V. , et al: Intraoperative duplex scanning of arterial reconstructions: Fate of repaired and unrepaired defects. J Vasc Surg 20:426-433,1994.

20.

Molnar GW , Read RC , Thompson BW : Vasospasm in the lower extremities during and following arterial reconstruction . J Cardiovasc Surg 20:359-368, 1979.

21.

Barner HB , Fischer VW , Beaudet L. : Effects of dilation with a balloon catheter on the endothelium of the internal thoracic artery. J Thorac Cardiovasc Surg 103:375-380, 1992.