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Assessment of donor limb hemodynamics in femorofemoral bypass for claudication
Insights
Femorofemoral bypass improves leg circulation for claudication but can worsen donor limb function. Careful patient selection is crucial due to potential hemodynamic deterioration in the donor limb after surgery.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Hemodynamics
Background:
- Iliac athero-occlusive disease commonly causes unilateral disabling claudication.
- Femorofemoral bypass is a surgical option for such conditions.
- Assessing hemodynamic changes in both limbs is critical post-surgery.
Purpose of the Study:
- To evaluate the hemodynamic outcomes of femorofemoral bypass surgery.
- To assess changes in ankle/brachial index and exercise response in both recipient and donor limbs.
- To determine the implications for patient selection and surgical outcomes.
Main Methods:
- Doppler arterial examination, including segmental pressures and ankle/brachial index, pre- and post-operatively.
- Treadmill exercise testing before and after femorofemoral grafting in a subset of patients.
- Analysis of hemodynamic data in symptomatic (recipient) and asymptomatic (donor) limbs.
Main Results:
- Significant improvement in resting ankle/brachial index in recipient limbs (0.54 to 0.76, P < 0.001).
- Improvement in exercise-induced hemodynamic abnormalities in recipient limbs.
- Deterioration in donor limb hemodynamics observed in 45% of patients, including new or worsened exercise limitations.
Conclusions:
- Femorofemoral bypass effectively improves hemodynamics in the symptomatic limb for iliac occlusive disease.
- A significant proportion of patients experience hemodynamic compromise in the donor limb, irrespective of superficial femoral artery patency.
- Strict patient selection is recommended to mitigate risks associated with donor limb deterioration.
Abstract:
During a 5-year period (1975 to 1980), 44 patients underwent femorofemoral bypass for unilateral disabling claudication caused by iliac atheroocclusive disease. All patients had complete Doppler arterial examination performed pre- and postoperatively, including segmental thigh and ankle pressure and calculation of an ankle/brachial (A/B) index for each limb. In 37 patients, standard treadmill exercise testing was performed before and after femorofemoral grafting. Hemodynamic improvement in the symptomatic limb was evidenced by an increase in resting A/B index from a mean of 0.54 +/- 0.14 before to 0.76 +/- 0.22 after operation (P less than 0.001). Exercise tests which were abnormal in all 37 recipient limbs preoperatively were improved. Six of the seven unimproved recipient limbs had associated femoropopliteal occlusion. Donor limb mean resting ankle/brachial index fell from 0.93 +/- 0.22 before to 0.83 +/- 0.22 after surgery (P less than 0.05). However, in 13 of 23 donor limbs, exercise response which had been normal before surgery became abnormal. Additionally, in 14 patients with abnormal donor limb exercise response before grafting, seven limbs had a significantly worsening of the exercise response postoperatively. These findings were not related to the patency of the superficial femoral artery in the donor limb. Deterioration in donor limb hemodynamics noted in 20 (45%) of the 44 patients in this series suggests that strict patient selection criteria should be maintained. Unlike in healthy subjects, an arteriographically patent atherosclerosis iliac artery may not support flow requirements of bilateral lower limb exercise.