A prospective study of Doppler pressures and segmental plethysmography before and following aortofemoral bypass. Implications for predicting success and for adopting a uniform method of classifying arterial disease.

To determine the clinical and hemodynamic changes associated with aortofemoral bypass, 44 limbs of 31 patients underwent segmental plethysmography (PVR) and Doppler pressures (DSP) before operation, immediately after operation, and again at 6 months. Prior to operation patients were separated by angiographic criteria into two groups: aortoiliac segment disease alone (AI) (n = 22), and aortoiliac and femoropopliteal segment disease (AIFP) (n = 22). At 6 months the two groups were subdivided into four groups based on relief (oSx) or lack of relief (+Sx) of symptoms. Before operation the only significant difference between the four groups was a higher thigh PVR and calf DSP in the AI + Sx group. Six month PVR values in AIoSx were improved nearly twofold over preoperative measurements at the thigh and calf, but at the thigh level only for AIFPxSx. DSP was increased at all three levels in both AI and AIFPoSx groups. No hemodynamic improvement occurred in either the AI or the AIFP + Sx groups. A derivative index of PVR (thigh-ankle/15 mm) or the FPomega was significantly lower in AIFOsSx before operation. There was a significant disparity between classification by hemodynamics and by symptoms prior to operation which lessened somewhat after operation. These studies suggest that success or failure can be predicted before operation in AIFP by FPomega, and arterial disease should be classified by a combination of symptoms, angiography, and hemodynamics.