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Salvage of the Ischemic LimbHemodynamic Changes During Surgery
Victor M. Bernhard, MD;
Ken Kayser, MS;
Joseph E. Gutierrez, MD;
Stuart D. Wilson, MD;
Richard E. Rodgers, MD;
Edwin H. Ellison, MD
JAMA. 1968;204(3):234-240.
Abstract
Limb salvage was achieved in 30 (77%) of 39 patients subjected to bypass surgery for end stage ischemia. Pressure gradients were reduced to zero after aortofemoral bypass; however, a small residual gradient was usually present after femoral-popliteal vein graft. Arterial flows were markedly increased at all levels following bypass. There was no difference in postoperative flow between patients whose limbs were salvaged and those with lesser degrees of ischemia. Average flow per extremity was 270 ml/min after aorto-iliac bypass and 100 ml/min after femoral-popliteal bypass. Local intra-arterial infection of papaverine hydrochloride increased flow to 170 ml/min following femoral-popliteal bypass. Ultimate flow potential of the limb may be estimated by this test. Failure to increase flow with papaverine suggests technical error.
Author Affiliations
From the Department of Surgery, Marquette University School of Medicine, and the Milwaukee County General Hospital, Milwaukee.
Footnotes
Read before the Seventh Multidiscipline Research Forum during the 116th annual convention of the American Medical Association, Atlantic City, NJ, June 21, 1967.
Reprint requests to 8700 W Wisconsin Ave, Milwaukee 53226 (Dr. Bernhard).
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