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Abstract
Occasionally patients undergo aortofemoral bypass grafting without benefit. Previously
we have documented that such patients can be identified at the time of hospital discharge
if the increase in ankle pressure index (ankle/arm systolic pressure, ΔAPI) is less
than 0.1. The present study was designed to assess the predictive value of intraoperative
measurement of ΔAPI following aortofemoral bypass in detecting patients who might
not benefit from this procedure alone. The API was measured by Doppler ultrasound
following induction of anesthesia and after arterial reconstruction, prior to wound
closure. The API was reassessed at regular intervals during the period of hospitalization
and during postoperative clinic visits. Studies were obtained on 72 symptomatic extremities
of 44 patients. Of 52 limbs with marked improvement or relief of claudication, all
but five had an intraoperative ΔAPI greater than or equal to 0.1. In eight limbs with
improved but continued moderate claudication, the intraoperative ΔAPI was between
−0.02 and +0.08. In all 11 extremities not benefited by aortofemoral bypass, the intraoperative
ΔAPI was less than or equal to 0.0. On the basis of this study, we would propose that
a concomitant bypass procedure distal to the inguinal ligament be considered in those
patients in whom the intraoperative ΔAPI is not greater than or equal to 0.1 following
aortofemoral bypass. This selective approach should treat the patient's symptoms more
completely and should avoid some secondary operations following aortofemoral bypass.
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Article info
Footnotes
☆Presented at the Thirty-fourth Annual Meeting of the Central Surgical Association, Buffalo, N. Y., March 3–5, 1977.
Identification
Copyright
© 1977 Published by Elsevier Inc.
