Document Detail

Functional assessment at the buttock level of the effect of aortobifemoral bypass surgery.
MedLine Citation:
PMID:  18438126     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Little is known about the prevalence of proximal (hip, buttock, lower back) claudication after aortobifemoral bypass (AF2B) grafting and its hemodynamic effects at the buttock level. METHODS: Forty-eight patients performed a treadmill test before and within 6 months after AF2B. The San Diego Claudication Questionnaire and the chest-corrected decrease from rest of transcutaneous oxygen pressure on buttocks were used to study exercise-induced proximal claudication and regional pelvic blood flow impairment. A decrease from rest of transcutaneous oxygen pressure value <-15 mm Hg was used to indicate regional blood flow impairment (RBFI). RESULTS: Patients had the following characteristics: 39 were men and 9 were women, 60 +/- 9 years, lowest ankle-to-brachial index (ABI) of 0.55 +/- 0.18 and maximal walking distance (MWD) on treadmill of 188 +/- 192 m at inclusion. ABI and MWD were significantly improved after surgery at 0.83 +/- 0.19 and 518 +/- 359 m (P < 0.0001). Unilateral or bilateral RBFI at the buttocks was found in 39 versus 29 patients before and after AF2B, respectively. Proximal claudication with underlying RBFI on one or both sides on treadmill were observed in 29 patients before AF2B, and in 9 of 26 (41%) versus 6 of 22 (23%) patients in end-to-end versus end-to-side proximal aorto-graft anastomosis of the AF2B, respectively (P < 0.05). CONCLUSION: A significant increase in MWD and ABI, but little improvement of proximal perfusion is observed after surgery, a finding that is expected from the absence of hypogastric artery revascularization. The prevalence of proximal claudication and proximal blood flow impairment is higher in case of end-to-end when compared with end-to-side proximal aorto-graft anastomosis, confirming the role of collaterals such as lumbar arteries in the buttock circulation during exercise in patients suffering from peripheral arterial disease. Proximal claudication on treadmill early after surgery affects almost one third of the patients and must not be underestimated among patients receiving AF2B. Attempts at hypogastric artery revascularization, if possible, might be preferable to decrease the risk of proximal claudication after AF2B.
Vincent Jaquinandi; Jean Picquet; Jean-Louis Saumet; Peyman Benharash; Georges Leftheriotis; Pierre Abraham
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  247     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-28     Completed Date:  2008-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  869-76     Citation Subset:  AIM; IM    
Department of Explorations Vasculaires, INSERM UMR 771, Université d'Angers, France.
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MeSH Terms
Aorta / surgery*
Buttocks / blood supply
Exercise Test
Femoral Artery / surgery*
Follow-Up Studies
Intermittent Claudication / diagnosis,  etiology*,  physiopathology*
Leg / blood supply
Middle Aged
Regional Blood Flow / physiology
Time Factors
Vascular Surgical Procedures / adverse effects*
Walking / physiology*

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