Preoperative Estimation of Run Off in Patients with Multiple Level Arterial Obstructions as a Guide to Partial Reconstructive Surgery

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Abstract
Preoperative measurements of direct femoral artery systolic pressure, indirect ankle systolic pressure and direct brachial artery systolic pressure were carried out in 9 patients with severe ischemia and arterial occlusions both proximal and distal to the ingvinal ligament. The pressure-rise at the ankle was estimated preoperatively by assuming that the ankle pressure would rise in proportion to the rise in femoral artery pressure. It was predicted that reconstruction of the iliac obstruction with aorta-femoral pressure gradients from 44-96 mm Hg would result in a rise in ankle pressure of 16-54 mm Hg. The actual rise in ankle pressure 1 mo. after reconstruction of the iliac arteries ranged from 10-46 mm Hg and was well correlated to the preoperative estimations. By proper pressure measurements the run-off problem of multiple level arterial occlusions can be evaluated. The result of successful partial reconstruction can be assessed preoperatively.