Runoff resistance and early graft failure in infrainguinal bypass surgery
G. A. Peterkin, W. W. LaMorte and J. O. Menzoian
Division of Surgery, Boston University Medical School, MA.
Recent reports suggest that intraoperatively measured runoff resistance can
identify patients destined for early graft failure. We measured runoff
resistance in 80 consecutive patients who had undergone infrainguinal
bypass surgery, and periodically assessed graft patency. There were 57
femoropopliteal bypass grafts and 23 infrapopliteal bypasses. After 3, 6,
or 12 months, there was no significant difference in mean resistance
between those grafts remaining patent and those that failed. Moreover,
among patients with very high resistance (greater than 1.2 mm Hg/mL/min),
12 bypass grafts remained patent for more than one year. These results
demonstrate that even patients with relatively high runoff resistance can
undergo successful bypass grafting. Consequently, patients with measured or
angiographic evidence of poor runoff should not be denied vascular
reconstruction on this basis alone. We believe that graft failure is a
multifactorial process in which the nature of the graft material, location
of the distal anastomosis, runoff resistance, and a number of other factors
are likely to play a role.
