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Unsuspected inflow disease in candidates for axillofemoral bypass operations: A prospective study
- Source :
- Journal of Vascular Surgery. 11:832-837
- Publication Year :
- 1990
- Publisher :
- Elsevier BV, 1990.
-
Abstract
- Routine arteriography of the axillary, subclavian, and innominate arteries before axillofemoral bypass surgery has not been advocated because of the presumed rarity of stenosis of these inflow vessels. However, we have noted in this patient population with extensive atherosclerosis that inflow disease can cause axillofemoral graft failure despite normal preoperative clinical and noninvasive parameters. We prospectively determined the incidence of unsuspected inflow stenosis with arteriography in 40 consecutive candidates for primary (28) or secondary (12) axillofemoral bypass surgery. A new arteriographic technique with a single translumbar puncture was developed to safely and clearly visualize the potential inflow and outflow tracts. Ten of the 40 patients (25%) exhibited inflow stenosis greater than 50% of luminal diameter (unilateral in eight patients and bilateral in two patients). Seven were on the left side (five subclavian, two axillary) and five were on the right side (three subclavian, one axillary, one innominate). In eight of the 40 patients (20%) the stenotic inflow lesion was ipsilateral to the ischemic leg and therefore proximal to the preferred inflow site of an axillofemoral bypass. Upper extremity arterial pressure measurements suggested potential inflow artery stenosis in only three of the 12 (25%) instances. These findings show that equal arterial pressures in the upper extremities do not ensure adequate inflow for an axillofemoral graft. Routine arteriographic assessment of inflow intacts is recommended before axillofemoral bypass surgery. (J VASC SURG 1990;11:832-7.)
- Subjects :
- medicine.medical_specialty
business.industry
Inflow
medicine.disease
Surgery
Stenosis
Blood pressure
medicine.anatomical_structure
Axillary artery
medicine.artery
Axillofemoral bypass
cardiovascular system
medicine
cardiovascular diseases
Derivation
Radiology
Prospective cohort study
business
Cardiology and Cardiovascular Medicine
Artery
Subjects
Details
- ISSN :
- 07415214
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- Journal of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....0ad8dac05ae03dc0fd39d9e2474ba2f9