Operative assessment of femorodistal bypass grafts using a new Doppler flowmeter

Operative measurements using a newly developed Doppler flowmeter were made on 47 in situ femorodistal bypass grafts performed for critical ischaemia. Graft blood flow, peripheral resistance and impedance were measured before and after the injection of 15 mg papaverine down the graft. The proportion of retrograde blood flow at the distal anastomosis was also measured. The success of a graft at 1 month was defined by patency on duplex ultrasound scanning, a rise in the Doppler ankle pressures and an improvement in the clinical state of the limb. By these criteria the 1-month primary success rate was 35 out of 47 (74 per cent). Graft blood flow was of little value in predicting graft outcome but, combined with segmental pressures, accurately located six of eight technical problems which were successfully corrected. After papaverine, the peripheral resistance of all the successful grafts fell below one peripheral resistance unit (PRU). No single measurement was able to completely distinguish between success and failure, although discriminant analysis of all measurements was able to predict success with a sensitivity of 100 per cent and specificity of 97 per cent. A simpler combination of a peripheral resistance after papaverine less than 1 PRU and a retrograde blood flow less than 33 per cent predicted success, with a sensitivity of 97 per cent and specificity 83 per cent. These criteria have been validated on a further 26 grafts, achieving a sensitivity of 88 per cent and a specificity of 75 per cent. Simple operative measurements, using a newly developed Doppler flowmeter, enable the detection of technical problems and the accurate prediction of the early outcome of femorodistal grafting.