IPC对动脉旁路移植术后血液动力学的影响.docVIP

IPC对动脉旁路移植术后血液动力学的影响 Haemodynamic effect of intermittent pneumatic compression of the leg after infrainguinal arterial bypass grafting K.T.Dells1, M.J. Husmannl, G. Szendro1, N.S.Peters2, J. H. N. Wolfe1 and A. O. Mansfield1 Regional Vascular Surgery Unit and2 Department of Academic Cardiology, St Marys Hospital, Imperial College School of Medicine, London, UK Correspondence to: Mr. K. T. Dells, 4 Abinger Court, 34 Gordon Road, London W5 2AF, UK (e-mail: k.delis@ic.ac.uk) Background: Intermittent pneumatic compression (IPC) may increase blood flow through infrainguinal arterial grafts, and has potential clinical application as blood flow velocity attenuation often precedes graft failure. The present study examined the immediate effects of IPC applied to the foot (IPCfoot), the calf (IPCfoot) and to both simultaneously (IPCfoot+calf) on the haemodynamics of infrainguinal bypass grafts. Methods: Eighteen femoropopliteal and 18 femorodistai autologous vein grafts were studied; all hada resting ankle brachial pressure index of 0.9 or more. Clinical examination, graft surveillance and measurement of graft haemodynamics were conducted at rest and within 5 s of IPC in each mode using duplex imaging. Outcome measures included peak systolic (PSV), mean (MV) and end diastolic (EDV)velocities, pulsatility index (PI) and volume flow in the graft. Results: All IPC modes significantly enhanced MV, PSV, EDV and volume flow in both grafttypes; IPCfoot+calf was the most effective. IPCfoot+calf enhanced median volume flow, MV and PSV infemoropopliteal grafts by 182, 236 and 49 per cent, respectively, and attenuated PI by 61 per cent. Enhancement in femorodistal grafts was 273, 179 and 53 per cent respectively, and PI attenuation was 63 per cent. Conclusion: IPC was effective in improving infrainguinal graft flow velocity, probably by reducing peripheral resistance. IPC has the potential to reduce the risk of bypass graft thrombosis. Presented to the Inaugural Meeting of the Society