Noninvasive Measurement of Shear Rate in Autologous and Prosthetic Bypass Grafts

Abstract

There is a major difference in thrombogenicity between lower extremity prosthetic and autologous vein bypass grafts, and arterial blood flow shear rate is known to influence thrombus formation. Despite this association, there has been little direct clinical observation of shear rates in bypass grafts. The authors developed a new noninvasive method to quantitate human arterial shear rate and used it in a pilot study to characterize differences in lower extremity bypasses. Shear rates were measured in 10 prosthetic and 14 autologous vein femoropopliteal bypass grafts. With CVI-M-mode color flow ultrasonography in resting supine patients, a velocity profile was recorded from a midgraft longitudinal section in the ultrasound beam direction. Shear rates were calculated by using a mathematical-graphic computer program at the anteromedial (near) and posterolateral (far) graft walls by averaging values immediately before and after peak systolic velocity (PSV). Comparison between prosthetic and autologous graft groups respectively revealed that differences in age (67 ± [S] vs 71 ± 10 yr), male gender (60% vs 43%), prevalence of hypertension (50% vs 71%), diabetes (40% vs 64%), smoking (50% vs 50%), hypercholesterolemia (30% vs 29%), coronary artery disease (60% vs 50%), and critical ischemia (60% vs 86%) did not reach statistical significance (p>0.19). Median PSVs were significantly less in prosthetic than in autologous vein bypasses (37 ± 13 vs 57 ±22 cm/s, p = 0.018). Prosthetic and autologous graft diameters were not statistically significantly different (6.3 ± 1.1 vs 5.6 ± 1.3 mm, p = 0. 18). Shear rates were significantly less in prosthetic than in autologous vein bypasses both at the near wall (382± 146 vs 698 +271 s-1, p=0.003) and at the far wall (551 ±235 vs 827 ±339 s-1, p=0.037). This mathematical model can be used to calculate shear rate from observed ultrasound flow patterns. Prosthetic bypass grafts had lower shear rates than autologous vein grafts.