A prospective study of hemodynamic changes associated with distal arterial bypass in the leg

Twelve limbs with Buerger's disease were examined by measurement of segmental blood pressure, digital arterial oxygen saturation and flow velocity in the foot, before and after distal arterial bypass grafting. Eight out of 12 grafts were patent in a follow-up of 6 months to 2 years and one month. Patients with low distal blood pressure before operation obtained a small increase of the foot and toe pressures postoperatively, whereas patients with relatively good initial distal blood pressure were likely to acquire a remarkable recovery of the foot and toe blood pressures. In all 8 limbs with successful revascularization, blood flow velocity in the foot returned to normal, while the foot or the toe pressures remained pathological in 7 of the 8 limbs and digital arterial oxygen saturation did not revert to normal in 4 limbs, with ulceration after healing of the lesion. Postoperative normalization of the foot flow velocity was predictive of limb salvage. The most characteristic feature of peripheral arterial occlusive disease is a stagnation in the microvascular circulation and improvement of the reduced flow velocity is a goal of surgical or conservative treatment.