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Postocclusive reactive hyperemia estimating peripheral vascular resistance: a noninvasive method to predict outcome
E Wahlberg1, P Olofsson, R Takolander
1Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
Objective:
The peripheral vascular resistance is an important factor determining the outcome of infrainguinal revascularizations. When measured intraoperatively, it correlates to graft patency, but to select patients to surgery a preoperative, preferably noninvasive, method is necessary. The aim of the present study is to test if parameters recorded during postocclusive reactive hyperemia can be used for that purpose.
Experimental Design:
This prospective study compares patients with occluded grafts within 30 days postoperatively to patients with patent grafts.
Setting:
University Hospital.
Patients:
Thirty patients with critical ischemia scheduled for infrainguinal bypass surgery.
Measures:
Correlations between intraoperatively measured peripheral resistance and preoperatively recorded parameters of postocclusive reactive hyperemia. The ability of the values to predict outcome.
Results:
Peripheral resistance correlated significantly to two parameters during postocclusive reactive hyperemia recorded after thigh occlusion, flux reappearance time (r=0.47, p=0.01) and time to peak flux (r=0.41, p=0.03). Intraoperative peripheral resistance predicted graft occlusion at 30 days with a 90% accuracy, while parameters obtained during reactive hyperemia, only tended to predict adverse outcome.
Conclusions:
Several parameters during reactive hyperemia show weak correlation to intraoperatively measured peripheral resistance, but none was able to accurately predict graft failure. Further studies are needed to evaluate its capability for patient selection.