Leg haemodynamics during reconstructive vascular surgery

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Abstract
The aim of this study was to find the best haemodynamic variables for a correct assessment of the function of a femoropopliteal bypass graft. The results are based on intraoperative measurements performed on 11 patients undergoing surgical reconstruction of the femoral artery with a femoropopliteal reversed saphenous vein bypass graft. Both blood transfusion and local intra-arterial injection of 40 mg of papaverine resulted in a significant increase in common femoral arterial and graft blood flows as well as in femoropopliteal pressure difference. At the same time there was a significant decrease in total leg and lower leg resistance, whereas the resistance over the graft was not significantly altered by changes in blood volume or by pharmacological vasodilatation. It was shown that, for a complete assessment of the bypass function, both the resistance in the graft and in the lower leg must be evaluated. This can be effected by simultaneously measuring both the blood pressure and the blood flow. It was also shown that the femoropopliteal pressure difference per se does not indicate the true capacity of the graft. It is concluded that, during reconstructive vascular surgery, leg haemodynamic variables are influenced by variations in blood volume and vasomotor tone. This is of importance for the correct interpretation of a single haemodynamic variable and for the correct quantitative evaluation of the results of vascular surgery.

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