Lee R E, Baird R N
Vascular Studies Unit, Bristol Royal Infirmary.
Eur J Vasc Surg. 1990 Apr;4(2):167-72. doi: 10.1016/s0950-821x(05)80432-3.
The femoro-femoral cross-over bypass has become a popular choice for the management of unilateral iliac artery disease, being used in preference to aorto-femoral or extraperitoneal ilio-femoral bypasses. It is a relatively minor procedure and associated with a small incidence of side effects, the main one being the risk of development of a steal of blood from the donor limb by the bypass. Although this problem has been widely discussed, haemodynamic studies have been limited by the use of indirect measurements of blood flow, such as ankle systolic pressures or by the use of electromagnetic flowmetry at the time of surgery. No study employing volumetric blood flow measurements to identify and quantify blood steal in the postoperative patient has been reported to date. With aims of studying the haemodynamic effects of a femoro-femoral cross-over bypass on the circulation in both the recipient and donor limbs, and of identifying preoperatively, problems likely to lead to haemodynamic problems or to graft failure, the present study of 31 patients undergoing femoro-femoral bypass was undertaken. The patients, 18 of whom had rest pain and 13 intermittent claudication, were studied preoperatively using arteriography and a non-invasive assessment. At 3 months from the operation, all received a clinical assessment and a further non-invasive assessment, including a measurement of blood volume flow. Flow measurements were made in the bypass at rest and during a reactive hyperaemia test. In addition, flow measurements were made in the donor limb below the bypass origin at rest and during hyperaemic testing of the recipient limb in order to assess any steal effect the bypass might cause to the donor limb circulation. All 31 patients were improved by surgery, but five developed donor limb claudication which was attributed to steal in three cases. Resting blood flow in the bypasses, 161 (65-282)ml/min [median (range)], rose by 116% (5-428%) to 300 (82-1114)ml/min after hyperaemic testing. Simultaneously, bypass hyperaemia caused a fall in donor limb blood flow of 32% (0-74%). Of the preoperative non-invasive tests, only donor femoral artery pulse rise time was related to the later development of objective evidence of steal. Successful Gruntzig dilatation of four major stenoses resulted in a satisfactory outcome.
股-股交叉旁路移植术已成为治疗单侧髂动脉疾病的常用选择，相较于主动脉-股动脉或腹膜外髂-股旁路移植术更受青睐。它是一种相对较小的手术，且副作用发生率较低，主要副作用是旁路移植导致供体肢体出现窃血的风险。尽管这个问题已被广泛讨论，但血流动力学研究一直受到间接血流测量方法的限制，如踝部收缩压测量，或手术时使用电磁血流计。迄今为止，尚未有研究采用体积血流测量来识别和量化术后患者的窃血情况。为了研究股-股交叉旁路移植术对受体和供体肢体循环的血流动力学影响，并在术前识别可能导致血流动力学问题或移植失败的问题，本研究对31例行股-股旁路移植术的患者进行了研究。这些患者中，18例有静息痛，13例有间歇性跛行，术前进行了动脉造影和无创评估。术后3个月，所有患者均接受了临床评估和进一步的无创评估，包括血容量流量测量。在静息状态和反应性充血试验期间对旁路移植血管进行流量测量。此外，在静息状态下以及受体肢体充血试验期间，对旁路移植血管起点以下的供体肢体进行流量测量，以评估旁路移植可能对供体肢体循环造成的任何窃血效应。所有31例患者术后病情均有改善，但有5例出现供体肢体跛行，其中3例归因于窃血。旁路移植血管的静息血流为161（65 - 282）ml/分钟[中位数（范围）]，充血试验后增加了116%（5 - 428%），达到300（82 - 1114）ml/分钟。同时，旁路充血导致供体肢体血流下降32%（0 - 74%）。在术前的无创检查中，只有供体股动脉脉搏上升时间与后期出现窃血的客观证据有关。成功对4处主要狭窄进行了Gruntzig扩张，结果令人满意。
