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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES VASCULAR PAPERS
The Journal of Cardiovascular Surgery 1999 Ottobre;40(5):683-9
Pressure traps in femoro-popliteal reversed vein grafts. Are valves culprits?
Robicsek F.* **, Thubrikar M. J.*, Fokin A.*, Tripp H. F.**, Fowler B.*
From the *Heineman Medical Research Laboratory and **Carolinas Heart Institute, Charlotte, North Carolina
Background. Stenosis is a major cause of vein graft failure in peripheral arterial surgery. Our goal is to determine whether vein valves play a role in this process by creating a “pressure trap”.
Methods. Seventeen patients with femoro-popliteal reversed saphenous vein grafts were studied intraoperatively. Flow and pressure in the grafts were measured, while the graft outflow was gradually occluded and released for 2-4 seconds. In 3 patients the graft flow was reduced by compressing calf muscles.
Results. Patients heart rates were 54-84 BPM, blood pressures 170/80-110/55 mmHg, and normal graft flow was 40-180 ml/min. In 12 patients with competent vein valves, at reduced flow (< 30 ml/min) the valves opened and closed in each cardiac cycle. At each closure the pressure was “trapped” distal to the valve producing diastolic hypertension. Also the flow was stagnant for a considerable portion of the cardiac cycle. Maximum diastolic pressure gradient across the valve ranged from 35 to 60 mmHg and the level of pressure trapped was inversely proportional to the graft flow.
Conclusions. In patients in whom reversed vein grafts with competent valves are placed in the femoro-popliteal positions a “pressure-trap” develops in the distal segment. This segmental hypertension combined with the flow stagnation could play an important role in the graft thickening and stenosis.