THE EFFECT OF POSTOCCLUSION REACTIVE HYPEREMIA, PAPAVERINE AND NIFEDIPINE ON DUPLEX DERIVED HEMODYNAMIC PARAMETERS OF INFRAINGUINAL BYPASS GRAFTS

Objectives: The aim of the present was to analyse the effects of vario us vasodilating stimuli on postoperative infrainguinal graft haemodyna mics. Design: Duplex derived haemodynamic parameters of infrainguinal bypass grafts were measured at rest and after postocclusion reactive h yperaemia, intraarterial papaverine (40 mgm) injection and peroral nif edipine (10 mg) administration. Setting: Department of Surgery, Univer sity Hospital. Materials: Twenty-nine patients with infrainguinal bypa ss grafts were studied by Duplex scanner after a median of 25 months p ostoperatively. Chief outcome measures: Peak systolic velocity (PSV), mean velocity (MV) and volume flow (VF) were measured at rest and afte r various stimuli. Main results: VF at rest increased from 125 +/- 16 ml/min (mean +/- S.E.M.) to 271 +/- 26 ml/min after papaverine adminis tration adn to 205 +/- 19 ml/min during reactive hyperaemia (p < 0.001 ). PSV, MV and VF increased to 154 +/- 21 ml/min after 30 min (p < 0.0 01) and there was a significant increase in MV (p < 0.05). Conclusions : Duplex derived flow measurement of infrainguinal bypass grafts can e valuate graft and limb haemodynamics in the postoperative period. Phar macological manipulations, such as vasodilation, can influence the phy siological runoff with subsequent increase in volume flow through the graft.