Unsuspected inflow disease in candidates for axillofemoral bypass operations

A prospective study

Keith D. Calligaro, Enrico Ascer, Frank J. Veith, Sushil K. Gupta, Kurt R. Wengerter, Charles D. Franco, Curtis W. Bakal, Seymour Sprayregen

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Routine arteriography of the axillary, subclavian, and innominate arteries before axillofemoral bypass surgery has not been advocated because of the presumed rarity of stenosis of these inflow vessels. However, we have noted in this patient population with extensive atherosclerosis that inflow disease can cause axillofemoral graft failure despite normal preoperative clinical and noninvasive parameters. We prospectively determined the incidence of unsuspected inflow stenosis with arteriography in 40 consecutive candidates for primary (28) or secondary (12) axillofemoral bypass surgery. A new arteriographic technique with a single translumbar puncture was developed to safely and clearly visualize the potential inflow and outflow tracts. Ten of the 40 patients (25%) exhibited inflow stenosis greater than 50% of luminal diameter (unilateral in eight patients and bilateral in two patients). Seven were on the left side (five subclavian, two axillary) and five were on the right side (three subclavian, one axillary, one innominate). In eight of the 40 patients (20%) the stenotic inflow lesion was ipsilateral to the ischemic leg and therefore proximal to the preferred inflow site of an axillofemoral bypass. Upper extremity arterial pressure measurements suggested potential inflow artery stenosis in only three of the 12 (25%) instances. These findings show that equal arterial pressures in the upper extremities do not ensure adequate inflow for an axillofemoral graft. Routine arteriographic assessment of inflow intacts is recommended before axillofemoral bypass surgery.

Original languageEnglish (US)
Pages (from-to)832-837
Number of pages6
JournalJournal of Vascular Surgery
Volume11
Issue number6
DOIs
StatePublished - 1990

Fingerprint

Prospective Studies
Pathologic Constriction
Upper Extremity
Angiography
Arterial Pressure
Axillary Artery
Brachiocephalic Trunk
Transplants
Subclavian Artery
Punctures
Leg
Atherosclerosis
Arteries
Incidence
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Unsuspected inflow disease in candidates for axillofemoral bypass operations : A prospective study. / Calligaro, Keith D.; Ascer, Enrico; Veith, Frank J.; Gupta, Sushil K.; Wengerter, Kurt R.; Franco, Charles D.; Bakal, Curtis W.; Sprayregen, Seymour.

In: Journal of Vascular Surgery, Vol. 11, No. 6, 1990, p. 832-837.

Research output: Contribution to journalArticle

Calligaro, KD, Ascer, E, Veith, FJ, Gupta, SK, Wengerter, KR, Franco, CD, Bakal, CW & Sprayregen, S 1990, 'Unsuspected inflow disease in candidates for axillofemoral bypass operations: A prospective study', Journal of Vascular Surgery, vol. 11, no. 6, pp. 832-837. https://doi.org/10.1016/0741-5214(90)90081-K
Calligaro, Keith D. ; Ascer, Enrico ; Veith, Frank J. ; Gupta, Sushil K. ; Wengerter, Kurt R. ; Franco, Charles D. ; Bakal, Curtis W. ; Sprayregen, Seymour. / Unsuspected inflow disease in candidates for axillofemoral bypass operations : A prospective study. In: Journal of Vascular Surgery. 1990 ; Vol. 11, No. 6. pp. 832-837.
@article{283a94a4fbbe4a65a674b05a91d4163c,
title = "Unsuspected inflow disease in candidates for axillofemoral bypass operations: A prospective study",
abstract = "Routine arteriography of the axillary, subclavian, and innominate arteries before axillofemoral bypass surgery has not been advocated because of the presumed rarity of stenosis of these inflow vessels. However, we have noted in this patient population with extensive atherosclerosis that inflow disease can cause axillofemoral graft failure despite normal preoperative clinical and noninvasive parameters. We prospectively determined the incidence of unsuspected inflow stenosis with arteriography in 40 consecutive candidates for primary (28) or secondary (12) axillofemoral bypass surgery. A new arteriographic technique with a single translumbar puncture was developed to safely and clearly visualize the potential inflow and outflow tracts. Ten of the 40 patients (25{\%}) exhibited inflow stenosis greater than 50{\%} of luminal diameter (unilateral in eight patients and bilateral in two patients). Seven were on the left side (five subclavian, two axillary) and five were on the right side (three subclavian, one axillary, one innominate). In eight of the 40 patients (20{\%}) the stenotic inflow lesion was ipsilateral to the ischemic leg and therefore proximal to the preferred inflow site of an axillofemoral bypass. Upper extremity arterial pressure measurements suggested potential inflow artery stenosis in only three of the 12 (25{\%}) instances. These findings show that equal arterial pressures in the upper extremities do not ensure adequate inflow for an axillofemoral graft. Routine arteriographic assessment of inflow intacts is recommended before axillofemoral bypass surgery.",
author = "Calligaro, {Keith D.} and Enrico Ascer and Veith, {Frank J.} and Gupta, {Sushil K.} and Wengerter, {Kurt R.} and Franco, {Charles D.} and Bakal, {Curtis W.} and Seymour Sprayregen",
year = "1990",
doi = "10.1016/0741-5214(90)90081-K",
language = "English (US)",
volume = "11",
pages = "832--837",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Unsuspected inflow disease in candidates for axillofemoral bypass operations

T2 - A prospective study

AU - Calligaro, Keith D.

AU - Ascer, Enrico

AU - Veith, Frank J.

AU - Gupta, Sushil K.

AU - Wengerter, Kurt R.

AU - Franco, Charles D.

AU - Bakal, Curtis W.

AU - Sprayregen, Seymour

PY - 1990

Y1 - 1990

N2 - Routine arteriography of the axillary, subclavian, and innominate arteries before axillofemoral bypass surgery has not been advocated because of the presumed rarity of stenosis of these inflow vessels. However, we have noted in this patient population with extensive atherosclerosis that inflow disease can cause axillofemoral graft failure despite normal preoperative clinical and noninvasive parameters. We prospectively determined the incidence of unsuspected inflow stenosis with arteriography in 40 consecutive candidates for primary (28) or secondary (12) axillofemoral bypass surgery. A new arteriographic technique with a single translumbar puncture was developed to safely and clearly visualize the potential inflow and outflow tracts. Ten of the 40 patients (25%) exhibited inflow stenosis greater than 50% of luminal diameter (unilateral in eight patients and bilateral in two patients). Seven were on the left side (five subclavian, two axillary) and five were on the right side (three subclavian, one axillary, one innominate). In eight of the 40 patients (20%) the stenotic inflow lesion was ipsilateral to the ischemic leg and therefore proximal to the preferred inflow site of an axillofemoral bypass. Upper extremity arterial pressure measurements suggested potential inflow artery stenosis in only three of the 12 (25%) instances. These findings show that equal arterial pressures in the upper extremities do not ensure adequate inflow for an axillofemoral graft. Routine arteriographic assessment of inflow intacts is recommended before axillofemoral bypass surgery.

AB - Routine arteriography of the axillary, subclavian, and innominate arteries before axillofemoral bypass surgery has not been advocated because of the presumed rarity of stenosis of these inflow vessels. However, we have noted in this patient population with extensive atherosclerosis that inflow disease can cause axillofemoral graft failure despite normal preoperative clinical and noninvasive parameters. We prospectively determined the incidence of unsuspected inflow stenosis with arteriography in 40 consecutive candidates for primary (28) or secondary (12) axillofemoral bypass surgery. A new arteriographic technique with a single translumbar puncture was developed to safely and clearly visualize the potential inflow and outflow tracts. Ten of the 40 patients (25%) exhibited inflow stenosis greater than 50% of luminal diameter (unilateral in eight patients and bilateral in two patients). Seven were on the left side (five subclavian, two axillary) and five were on the right side (three subclavian, one axillary, one innominate). In eight of the 40 patients (20%) the stenotic inflow lesion was ipsilateral to the ischemic leg and therefore proximal to the preferred inflow site of an axillofemoral bypass. Upper extremity arterial pressure measurements suggested potential inflow artery stenosis in only three of the 12 (25%) instances. These findings show that equal arterial pressures in the upper extremities do not ensure adequate inflow for an axillofemoral graft. Routine arteriographic assessment of inflow intacts is recommended before axillofemoral bypass surgery.

UR - http://www.scopus.com/inward/record.url?scp=0025364413&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025364413&partnerID=8YFLogxK

U2 - 10.1016/0741-5214(90)90081-K

DO - 10.1016/0741-5214(90)90081-K

M3 - Article

VL - 11

SP - 832

EP - 837

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -