Ultraschall Med 2007; 28 - P_4_6
DOI: 10.1055/s-2007-988965

In-vivo hemodynamic assessment after above-knee femoropopliteal bypass using the DynafloTM prosthesis

T Fischer 1, R Rückert 2, N Tsilimparis 2, A Thomas 3
  • 1University Berlin, Charité, Institute of Radiology, Berlin, Germany
  • 2Franziskus-Krankenhaus, chirurgische Klinik, Berlin, Germany
  • 3University Berlin, Charité, Department of Gynecology and Obstetrics, Berlin, Germany

Aim: An ePTFE prosthesis (DynafloTM) was developed to improve the clinical outcome after above-knee femoropopliteal bypass. The prosthesis aims to reduce intimal hyperplasia (IH). The hemodynamic effect of this prosthesis has been investigated in vitro while only little in-vivo data is available.

Methods: In a prospective study, 30 DynafloTM prostheses were implanted in 29 patients. 27 of the bypasses are still patent. The patients are currently undergoing investigation of hemodynamics in a two years period using color duplex ultrasound (CDUS) and ultrasound after contrast medium (USCM) administration (SonoVue). The following parameters were investigated: flow volume in the anastomosis and distal receiving vessel, CDUS, signal intensity curve in the anastomotic area; demonstration of the postulated vortexing and visualization of wall lesions (thrombus, IH).

Results: The distal bypass anastomosis could be assessed with CDUS in 20 cases and with USCM in 28 of 30 cases (p<0.05). Typical vortexing was demonstrated with USCM in 23 cases and with CDUS in 10 cases. The primary patency rate after a median follow-up of 12 months was 70%. In four cases an intervention (PTA) was performed due to the presence of thrombotic wall deposits that were detected only by USCM.

Conclusions: New USCM and technical advances improve the hemodynamic assessment of blood flow by US compared with CDUS. This may improve the in-vivo hemodynamic assessment after DynafloTM bypass grafting. The two-dimensional display limits spatial and temporal quantification of flow phenomena at the anastomotic site. The use of USCM has the potential to overcome this limitation.