The predictive value of blood flow velocity in femoro-distal bypass

Changes in postocclusive reactive hyperaemic values as measured with laser Doppler fluxmetry after infrainguinal arterial reconstructions

OBJECTIVES

The aim of the present study was to evaluate microcirculartory changes of the postocclusive reactive hyperaemia test measured with Laser Doppler fluxmetry to detect results of arterial reconstructions.

DESIGN

Prospective open study.

SETTING

Vascular laboratory of a University Hospital.

MATERIAL

Sixty patients with peripheral arterial occlusive disease who underwent infrainguinal reconstruction were examined the day before and 1-2 days after surgery.

CHIEF OUTCOME MEASURES

The values were obtained during postocclusive reactive hyperaemia induced by release of a 3 min arterial occlusion with a cuff at ankle level with the laser Doppler probe placed dorsally on the first toe. The alterations after surgery in these hyperaemia parameters were compared to changes in ankle/brachial index and clinical improvement at 30 days postoperatively.

MAIN RESULTS

Patients improved by surgery according to ankle/brachial index had significantly reduced time to peak (p < 0.001) and significantly increased resting flux value (p < 0.05) and peak flux value (p < 0.05). There was a significant correlation between the change after surgery in time to peak flux and increment of ankle/brachial index (r = 0.63, p < 0.001).

CONCLUSIONS

Changes in reactive hyperaemia values as measured with laser Doppler fluxmetry, especially the time to peak flux, seem to detect circulatory changes caused by arterial reconstructions.

Praxilene (naftidrofuryl oxalate) as an alternative for the augmentation of femoro-distal bypass blood flow

In 30 patients undergoing femoro-distal bypass the effect of papaverine and praxilene on blood flow in the graft was measured. The mean resting flow was 129 ml min-1 (range: 91-167) and after papaverine was 202 ml min-1 (142-262) and after praxilene was 205 ml min-1 (143-267). Praxilene has a similar effect to papaverine in the augmentation of blood flow, and further investigation is needed to see if long-term praxilene administration might improve graft survival.