Segmental air plethysmography during arterial reconstruction

Abstract

Summary Sixty-one patients undergoing 83 lower limb reconstructions for chronic arterial ischaemia or aortic aneurysm from April 1977 to March 1979 were monitored intraoperatively using the pulse volume recorder (PVR), Doppler auscultation and palpation of pedal pulses. Nine technical defects (11 per cent) were recognized 5 min after declamping and corrected before the operative wound was closed. In 31 grafts to the popliteal artery median ankle PVR amplitude increased from 4·5 mm (95 per cent confidence limits, 2–6 mm) at the start of the operation to 18 mm (14–21 mm, P < 0·0001 Wilcoxon). Four poor PVR wave forms were successfully improved by operative revision. Initial median calf PVR amplitude with isolated aortic or iliac artery occlusions in 30 limbs was 41 mm (29–56 mm), similar to that in 22 control limbs (38 mm, 28–53 mm), and did not alter following successful reconstruction. In this group there were 2 operative revisions and all grafts were patent postoperatively. In successful proximal reconstructions of 22 severely ischaemic limbs with combined proximal and distal disease, median PVR amplitude fell from 10·5 mm (6·5–14 mm) to 8 mm (6·5–15 mm, not significant). There were 3 operative revisions and all grafts remained patent postoperatively. In this group with combined proximal and distal disease pulse wave transit time (R wave of ECG to peak calf PVR wave form) became shortened from 577 ms (542–633 ms) to 481 ms (467–495 ms, P < 0·05). Where operative correction was required, transit time on initial declamping became prolonged but fell to less than the pre-reconstruction transit time following successful revision. These results suggest that the information provided by intraoperative monitoring with the PVR will contribute towards a reduction in early graft occlusions and re-explorations in the postoperative period.