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Theoretical hydraulic consequences of vein graft taper

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Presentation on theme: "Theoretical hydraulic consequences of vein graft taper"— Presentation transcript:

1 Theoretical hydraulic consequences of vein graft taper
Sang-Wook Lee, MS, Michael A Curi, MD, MPA, Zachary K Baldwin, MD, Viji Balasubramanian, PhD, Francis Loth, PhD, Lewis B Schwartz, MD  Journal of Vascular Surgery  Volume 38, Issue 4, Pages (October 2003) DOI: /S (03)

2 Fig 1 Intraoperative hemodynamic measurements in a 100 cm nonreversed translocated femoroperoneal vein graft. Left panel, Proximal and distal pressure; middle panel, pressure gradient; right panel, blood flow. Waveforms are unfiltered and are an ensemble average of 10 seconds of data. Pressure measured by fluid-filled catheter transduction and flow by ultrasonic transit-time flowmetry. Journal of Vascular Surgery  , DOI: ( /S (03) )

3 Fig 2 Longitudinal impedance modulus (top) and phase angle (bottom) measured intraoperatively in a femoroperoneal bypass graft. Integration of impedance curve over 4 Hz revealed a ∫ZL value of 32 × 103 dyne/cm5 (see text). Journal of Vascular Surgery  , DOI: ( /S (03) )

4 Fig 3 Input impedance modulus (top) and phase angle (bottom) measured intraoperatively in a femoroperoneal bypass graft. Journal of Vascular Surgery  , DOI: ( /S (03) )

5 Fig 4 Calculation of percent graft taper in 100 cm grafts with geometric mean 4.2 mm. Graft taper is calculated as (proximal diameter − distal diameter)/proximal diameter. Note that grafts are depicted in greatly exaggerated scale. Diameter scale is enlarged 10-fold compared with length scale, to illustrate taper. Journal of Vascular Surgery  , DOI: ( /S (03) )

6 Fig 5 Comparison of pressure gradient measured intraoperatively (Measured ΔP) versus gradient calculated from Womersley equation (Calculated ΔP). Assumed constants include length, 100 cm; diameter, 5.2 mm; viscosity of blood, poise. Journal of Vascular Surgery  , DOI: ( /S (03) )

7 Fig 6 Comparison of ZL with ΔP measured intraoperatively (Measured ΔP) versus ZL with ΔP calculated from Womersley equation (Calculated ΔP). Assumed constants include length, 100 cm; diameter, 5.2 mm; viscosity of blood, poise. Integrating over 4 Hz yielded ∫ZLmeasured, 34 × 103 dyne/cm5, compared with ∫ZLcalculated, 32 × 103 dyne/cm5. Journal of Vascular Surgery  , DOI: ( /S (03) )

8 Fig 7 Effect of diameter on ZL in straight 100 cm vein grafts. Note steadily increasing ZL spectra with decreasing diameter. Note also that higher harmonic values increased in greater proportion to mean and lower harmonic values. ZL curves for 2.2 and 1.2 mm grafts are too high to be plotted on this scale. Journal of Vascular Surgery  , DOI: ( /S (03) )

9 Fig 8 Relationship between diameter and ∫ZL in 100 cm vein grafts. Note nonlinear inverse relationship with greatly increased ∫ZL at diameter less than 4.0 mm. ∫ZL for graft diameter of 1.2 mm was too high to be plotted on this scale (2810 × 103 dyne/cm5). Journal of Vascular Surgery  , DOI: ( /S (03) )

10 Fig 9 Relationship between percent taper and ZL in tapered 100 cm vein grafts with geometric mean 4.2 mm. Note that moderate amount of taper (<40%) has little effect on ZL. Journal of Vascular Surgery  , DOI: ( /S (03) )

11 Fig 10 Relationship between percent taper and ∫ZL in tapered 100 cm vein grafts with geometric mean 4.2 mm. Note that tapering has little effect on ∫ZL until level of about 60% (5.6 → 2.8 mm). Journal of Vascular Surgery  , DOI: ( /S (03) )

12 Fig 11 Relationship between percent taper and ∫ZL in tapered 100 cm vein grafts with geometric mean 3.2, 4.2, and 5.2 mm. Note that even more profound tapering is well-tolerated in grafts with larger geometric mean. Journal of Vascular Surgery  , DOI: ( /S (03) )

13 Fig 12 Relationship between percent taper and effective hemodynamic diameter (EHD) in tapered 100 cm vein grafts with geometric mean 3.2, 4.2, and 5.2 mm. Note that EHD for a given graft size remains fairly constant until greater than 50% taper. Journal of Vascular Surgery  , DOI: ( /S (03) )

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