Salvage of the ischemic limb. Hemodynamic changes during surgery

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.