Skip to main content
SpringerLink
Log in

Die intraoperative Messung der hydraulischen Impedanz—ein Prognosekriterium für die Offenheitsrate femorokruraler Bypässe

  • Originalarbeit
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Bei 68 femorokruralen PTFE-Bypassanlagen wurde mit Hilfe der extrakorporalen Bypassflowmessung (EBF) die hydraulische Impedanz sowohl des gesamten Abstromgebietes als auch der selektiven distalen ante- und retrograden Ausstromregionen gemessen. Bei der EBF-Methode wird ein Silikonschlauch temporär zwischen die A. femoralis communis und dem kruralen Anschlussgefäß platziert. In diesem temporären Bypass befanden sich ein elektromagnetischer Flussmesskopf sowie ein Anschluss zur Druckmessung. Die gemessenen hämodynamischen und Impedanzparameter wurden mit den primären und sekundären Offenheitsraten der Bypässe nach 3 Jahren korreliert.

Es zeigte sich, dass eine distale Flussaufteilung im Verhältnis von 1:1 bei kruralen Ausstromverhältnissen bestand. Im Mittel flossen 65 ml/min nach distal und 70 ml/min nach proximal. Von allen untersuchten Parametern zeigte sich lediglich der erste Impedanzphasenwinkel, welcher den Wellenwiderstand charakterisiert, als statistisch signifikant mit den Offenheitsraten nach 3 Jahren verbunden. Während der Grenzwert für den totalen Abstromwiderstand −40° (p<0,01) betrug, waren es -33° (p<0,05) beim selektiven retrograden und −45° (p<0,01) beim antegraden Ausstrom.

Abstract

Hydraulic impedance was measured intra-operatively in 68 femoro-crural reconstructions. Using the extracorporeal-bypass-flow (EBF) method, both the total as well as selective ante- and retrograde outflows were obtained. The EBF method uses silastic tubing, which we inserted temporarily between the common femoral artery and the distal runoff vessel. Included in the tube were a flow-meter probe and a pressure transducer. Hemodynamic and impedance parameters were recorded and related to graft outcome after 3 years.

A distal flow-split of 1:1 was observed for crural runoff. A mean retrograde blood flow of 65 ml/min was found with an antegrade flow of 70 ml/min. Of all studied parameters, only the first impedance phase angle, which characterizes the pulsatile resistance, correlated with long-term graft patency. For the total runoff, a cut-off value of −40° (p<0.01) was statistically significantly related, while for the antegrade runoff an angle of −33° (p<0,05) and for the retrograde outflow a value of −45° (p<0,01) were determined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Alback A, Roth WD, Ihlberg L, Biancari F, Lepantalo M (2000) Preoperative angiographic score and intraoperative flow as predictors of the mid-term patency of infrapopliteal bypass grafts. Eur J Vasc Endovasc Surg 20: 447–453

    Article  CAS  PubMed  Google Scholar 

  2. Albrechtsen D (1976) Intra-operative haemodynamic findings and their prognostic significance in femoropopliteal reversed saphenous vein graft bypass operations. Scand J Thorac Cardiovasc Surg10: 67–76

    Google Scholar 

  3. Ascer E, Veith FJ, Morin L et al. (1984) Quantitative assessment of outflow resistance in lower extremity arterial reconstructions. J Surg Res 37: 8–15

    CAS  PubMed  Google Scholar 

  4. Ascer E, Veith FJ, White-Flores SA et al. (1987) Intraoperative outflow resistance as a predictor of late patency of femoropopliteal and infrapopliteal arterial bypasses. J Vasc Surg 5: 820–827

    Article  CAS  PubMed  Google Scholar 

  5. Barner HB, Kaminski DL, Codd JE, Kaiser GC, Willman VL (1974) Hemodynamics of autogenous femoropopliteal bypass. Arch Surg 109: 291–293

    CAS  PubMed  Google Scholar 

  6. Beard JD, Scott DJ, Skidmore R, Baird RN, Horrocks M (1989) Operative assessment of femorodistal bypass grafts using a new Doppler flowmeter. Br J Surg 76: 925–928

    CAS  PubMed  Google Scholar 

  7. Cooper GG, Austin C, Fitzsimmons E et al. (1990) Outflow resistance and early occlusion of infrainguinal bypass grafts. Eur J Vasc Surg 4: 279–283

    CAS  PubMed  Google Scholar 

  8. Davies AH, Magee TR, Horrocks M (1993) Intraoperative measurement of vascular graft resistance as a predictor of early outcome. Br J Surg 80: 854–857

    CAS  PubMed  Google Scholar 

  9. Heise M, Kruger U, Settmacher U et al. (1999) A new method of intraoperative hydraulic impedance measurement provides valuable prognostic information about infrainguinal graft patency. J Vasc Surg 30: 301–308

    CAS  PubMed  Google Scholar 

  10. Heise M, Kruger U, Pfitzmann R et al. (2001) The influence of intraarterial prostaglandin E(1) on vascular hydraulic impedance and infrainguinal graft patency. Eur J Vasc Endovasc Surg 22: 219–225

    Article  CAS  PubMed  Google Scholar 

  11. Henneken V, Bischoff-Everding C, Frank J et al. (1992) Einfluss des Abflusswiderstands auf die Ergebnisse in der kruralen Arterienchirurgie. Vasa (Suppl) 36: 42–47

  12. Johnson WC, Lee KK (2000) A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularization: a prospective randomized Department of Veterans Affairs cooperative study. J Vasc Surg 32: 268–277

    Article  CAS  PubMed  Google Scholar 

  13. Krüger U, Heise M, Scholz H, Bürger K (1997) Der komplexe periphere Widerstand—ein Prognosekriterium für die Offenheitsrate peripherer Gefäßbypässe? Vasa (Suppl) 48: 11–15

    Google Scholar 

  14. Lang W, Schweiger H (1992) Die intraoperative Messung des peripheren Widerstands zur Qualitätskontrolle bei infrainguinalen Gefäßrekonstruktionen. Vasa (Suppl) 35: 79–80

    Google Scholar 

  15. Li XM, Rittgers SE (2001) Hemodynamic factors at the distal end-to-side anastomosis of a bypass graft with different POS: DOS flow ratios. J Biomech Eng 123: 270–276

    Article  CAS  PubMed  Google Scholar 

  16. Mamode N, Scott RN (2000) Graft type for femoro-popliteal bypass surgery. Cochrane Database Syst Rev 2: CD001487

    PubMed  Google Scholar 

  17. McDonald DA (1955) The relation of pulsatile pressure to flow in arteries. J Physiol 127: 533–552

    Google Scholar 

  18. Menzoian JO, La Morte WW, Cantelmo NL et al. (1985) The preoperative angiogram as a predictor of peripheral vascular runoff. Am J Surg 150: 346–352

    CAS  PubMed  Google Scholar 

  19. Milnor WR (1989) Vascular Impedance. In: Milnor WR (ed) Hemodynamics. Wiliams & Williams, Baltimore, pp167–203

  20. O’Rourke MF, Taylor MG (1966) Vascular impedance of the femoral bed. Circ Res 18: 126–139

    Google Scholar 

  21. Parvin SD, Evans DH, Bell PR (1985) Peripheral resistance measurement in the assessment of severe peripheral vascular disease. Br J Surg 72: 751–753

    CAS  PubMed  Google Scholar 

  22. Peterkin GA, LaMorte WW, Menzoian JO (1988) Runoff resistance and early graft failure in infrainguinal bypass surgery. Arch Surg 123: 1199-1201

    CAS  PubMed  Google Scholar 

  23. Ruckert RI, Settmacher U, Kruger U, Scholz H (2000) Femorodistal PTFE bypass grafting for severe limb ischaemia: results of a prospective clinical study using a new distal anastomotic technique. Eur J Vasc Endovasc Surg 20: 51–56

    Article  CAS  PubMed  Google Scholar 

  24. Rutherford RB, Jones DN, Bergentz SE, Bergqvist D et al. (1988) Factors affecting the patency of infrainguinal bypass. J Vasc Surg 8: 236–246

    Article  CAS  PubMed  Google Scholar 

  25. Schwartz LB, Purut CM, O’Donohoe MK et al. (1991) Quantitation of vascular outflow by measurement of impedance. J Vasc Surg 14: 353–363

    Article  CAS  PubMed  Google Scholar 

  26. Sottiurai VS, Yao JS, Flinn WR, Batson RC (1983) Intimal hyperplasia and neointima: An ultrastructural analysis of thrombosed grafts in humans. Surgery 93: 809–817

    CAS  PubMed  Google Scholar 

  27. Veith FJ, Gupta SK, Ascer E et al. (1986) Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg 3: 104–114

    Google Scholar 

  28. Vos GA, Rauwerda JA, van den Broek TA, Bakker FC (1989) The correlation of peroperative outflow resistance measurements with patency 109 infrainguinal arterial reconstructions. Eur J Vasc Surg 3: 539–542

    Google Scholar 

  29. Wolfle KD, Bruijnen H, Loeprecht H et al. (1992) Bestimmung des Abflusswiderstandes bei Bypassoperationen mit infragenualem Anschluss: Ist dadurch eine Pradiktion des Fruhverschlusses moglich? Vasa (Suppl) 36: 35–41

    Google Scholar 

  30. Wolfle KD, Bruijnen H, Morski A et al. (1999) The importance of graft blood flow and peripheral outflow resistance for early patency in infrainguinal arterial reconstructions. Vasa 28: 34–41

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein- und Transplantationschirurgie, Humboldt-Universität zu Berlin

    M. Heise, S. Schmidt, S. Sklenar, P. Neuhaus & U. Settmacher

  2. Abteilung für Gefäßchirurgie, Königin-Elisabeth-Krankenhaus Herzberge

    U. Krüger & H. Scholz

  3. Klinik für Allgemein- und Transplantationschirurgie, Humboldt-Universität zu Berlin, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin

    M. Heise

Authors
  1. M. Heise
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Krüger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Sklenar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Neuhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Scholz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. Settmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Heise.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heise, M., Krüger, U., Schmidt, S. et al. Die intraoperative Messung der hydraulischen Impedanz—ein Prognosekriterium für die Offenheitsrate femorokruraler Bypässe. Gefässchirurgie 8, 304–311 (2003). https://doi.org/10.1007/s00772-003-0297-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00772-003-0297-0

Schlüsselwörter

Keywords

Search

Navigation