Purpose: Our purpose was to investigate the hemodynamic theory that th
e blood flow rate through a stenotic arterial graft is limited by the
onset of turbulence, which acts as a barrier at peak systole against f
urther increases in systolic flow. Methods: We used duplex ultrasonogr
aphy to examine 25 stenotic infrainguinal vein grafts. Theory predicts
that the flow limitation occurs at peak systole at a stenotic velocit
y greater than 250 cm/sec, which corresponds to a residual stenotic lu
menal diameter of 0.36 cm (Reynolds No. 2000). These numbers are based
on the assumption that the 68 ml/min blood flow is supplied by the fe
moropopliteal graft to the resting lower leg only during systole. When
the lumen is smaller than 0.36 cm, peak systolic velocity (PSV) must
exceed 250 cm/sec. The increased velocity results in poststenotic turb
ulence. This turbulent condition restricts the averaged graft systolic
flow to less than the 68 ml/min required by the lower leg, so diastol
ic flow is needed to make up the deficit. Results: Twenty vein grafts
with PSVs of 250 cm/sec or greater had end-diastolic velocities of 50
cm/sec or greater as predicted; three grafts with PSVs of 256 to 300 c
m/sec and two grafts with PSVs of less than 250 cm/sec had no forward
diastolic flow (p = 0.03). None of 10 normal grafts had forward diasto
lic flow. Conclusion: The onset of turbulence in a stenotic vein graft
supplying the lower leg occurs at a PSV of 250 cm/sec or greater. The
appearance of diastolic Bow maintains the average graft volume flow.