Document Detail

Hemodynamics of infrapopliteal PTFE bypasses and adjunctive arteriovenous fistulas.
MedLine Citation:
PMID:  12664047     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Blood flow, pressure and peripheral resistance in patients with established polytetrafluoroethylene (PTFE) grafts and adjunctive arteriovenous fistulas (AVF) have rarely been investigated. To better elucidate the effects of this AVF, we obtained noninvasive measurements of hemodynamic variables in patients with infrapopliteal PTFE grafts and an AVF. METHODS:. Systolic, mean and diastolic arm and toe pressures were measured with an oscillometric technique employed in automatic blood pressure monitors. Peak-systolic velocity, end-diastolic velocity and flow rates at the graft and recipient distal artery were measured with duplex ultrasound. Resistance for the leg and foot in peripheral resistance units ( PRU ) was estimated as mean arm pressure divided by graft flow rate and as mean toe pressure divided by distal artery flow rate respectively. We analyzed data from 21 patients. Toe pressures were measurable in 13 patients. Bypass graft inflow was at the external iliac artery in 11 patients, common femoral in six, common iliac in two and superficial femoral in two. The distal anastomosis was at the anterior tibial artery in 10 patients, peroneal in seven and posterior tibial in four patients. RESULTS:. Graft systolic and diastolic velocities were 91+/-46 (mean+/-sd) and 38+/-31 (mean+/-sd) cm/s respectively. Toe systolic pressure averaged 81+/-28 (mean+/-SD) mmHg with a corresponding toe/brachial index (TBI) of 0.53+/-0.18 (mean+/-SD). The ratio between arm mean pressure, 104+/-20 (mean+/-SD) mmHg, and graft flow rate, 413+/-290 (mean+/-sd) ml/min, yielded an estimated leg resistance of 0.32+/-0.20 peripheral resistance units (PRU) (mean+/-sd). The ratio between mean toe pressure, 51+/-21 (mean+/-SD) mmHg, and distal artery flow rate, 37+/-26 (mean+/-SD) ml/min, produced an estimated foot resistance averaging 1.66+/-1.18 PRU (mean+/-sd). CONCLUSIONS: Average graft flow rate was five times greater than flow reported for standard tibial bypasses. Although distal artery flow rate and graft peak systolic velocity were within reported normal ranges, mean toe pressure and toe-brachial index were below normal. Leg and foot resistances were decreased. These data suggest that bypasses with arteriovenous fistulas have increased flow, desirable for graft patency, but may affect distal perfusion pressure.
S Kallakuri; E Ascher; A Hingorani; T Jacob; S Salles-Cunha
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular surgery (London, England)     Volume:  11     ISSN:  0967-2109     ISO Abbreviation:  Cardiovasc Surg     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-03-28     Completed Date:  2003-07-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9308765     Medline TA:  Cardiovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  125-9     Citation Subset:  IM    
Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, New York 11219, USA.
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MeSH Terms
Aged, 80 and over
Arteriovenous Shunt, Surgical*
Blood Pressure
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation
Follow-Up Studies
Ischemia / physiopathology,  surgery*
Leg / blood supply*
Middle Aged
Regional Blood Flow
Ultrasonography, Doppler, Color
Vascular Resistance
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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