Monitoring arterial surgery: a comparison of pulse volume recording and electromagnetic flowmetering in aortofemoral reconstruction.

ABSTRACT

Intraoperative monitoring of aortofemoral reconstruction using Pulse Volume Recordings (PVR) and Doppler ankle systolic pressure indices (ASPI) is compared with volume blood flow obtained by electromagnetic flowmetering (EMF). Twenty-five patients aged 45-78 with limb ischaemia or abdominal aortic aneurysm were studied before and 20 minutes after reconstruction. Reconstruction of isolated iliac occlusions (25 limbs) produced immediate improvement in PVR results. PVR waveform pulsatility (upstroke time shortened; 249-183 msec, p = less than .001) was more sensitive than amplitude which was restored to pre-reconstruction levels (16.1 to 17.5 mm). Similar trends were seen in multisegment disease. PVR transit time was not as sensitive. EMFlow was increased in both groups (229-600 and 160-308 mls/min). ASPI was not useful. Both PVR amplitude and pulsatility were significantly correlated with EMF volume flow, but pulsatility was more sensitive and was a superior predictor of successful arterial revascularisation. Technical errors were detected and corrected, and 94% of grafts were patent on discharge. These results show a correlation between PVR pulse waveform shape and EMFlow to such an extent that PVR results may be taken as a useful indicator of successful arterial reconstruction.