Flow measurement before and after papaverine injection in above-knee prosthetic femoropopliteal bypass

• Published in: Journal of vascular surgery 2006-04, Vol.43 (4), p.729-734
• Main Authors: Pedersen, Gustav, Laxdal, Elin, Amundsen, Svein Roar, Dregelid, Einar, Jonung, Torbjørn, Nyheim, Thomas, Aune, Steinar
• Format: Article
• Language: English
• Subjects: Angiography; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - surgery; Biological and medical sciences; Blood Flow Velocity - physiology; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Cohort Studies; Female; Femoral Artery - surgery; Follow-Up Studies; Humans; Injections, Intralesional; Male; Medical sciences; Monitoring, Intraoperative; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Orthopedic surgery; Papaverine - therapeutic use; Popliteal Artery - surgery; Probability; Proportional Hazards Models; Prosthesis Design; Prosthesis Failure; Renovascular diseases; Retrospective Studies; Risk Assessment; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascular Patency - drug effects; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2005.12.041

To investigate the value of intraoperative blood flow measurements on early and long-term patency of above-knee prosthetic femoropopliteal bypass. Flow was measured with a transit time flowmeter before (basal flow) and after an intragraft injection of papaverine (papaverine flow) in 87 operations (86 patients) between January 1990 and December 2001. Sixty-one grafts were of polyester, and 26 were of polytetrafluoroethylene. The operations were done under epidural anesthesia. The preoperative angiographic run-off score and clinical risk factors were recorded. Patency rates were analyzed with the product limit method and compared with the log-rank test. Variables found to be near significantly related to patency rates (P < .1) were included in a multivariate analysis performed with the Cox proportional hazard model. Basal flow measurements were not related to patency. The 2- and 5-year patency rates for grafts with a papaverine flow ≤500 mL/min were 48% and 18% compared with 66% and 52% for grafts with a papaverine flow ≥500 mL/min. These differences were statistically significant (P = .012, hazard ratio, 2.6). Two- and 5-year patency rates for smokers vs nonsmokers were 44% and 18% vs 69% and 54%. The patency rates for patients with poor vs good run-off were 42% and 27% vs 66% and 31%. Smoking (P = .008, hazard ratio, 2.75) and poor run-off score (P = .009, hazard ratio, 2.38) were found to be independent risk factors for reduced patency rates. Poor run-off score did not correlate with low values of measured basal or papaverine flow. Papaverine flow of ≤500 mL/min is associated with reduced mid- and long-term patency rates. Additional antithrombotic medication and frequent follow-up for these grafts should be considered. The inferior patency rates of smokers and patients with poor run-off indicate that prosthetic bypass is less suitable for these groups of patients.