Clinical Use of Blood Flowmeters

Sako, Y.
April 1984
Angiology;Apr1984, Vol. 35 Issue 4, p206
Academic Journal
The concept of an electromagnetic flowmeter was first described by Kolin in 1936.1 He demonstrated that with the flowmeter which required surgical exposure of the blood vessel for probe contact but not requiring cannulation, it was possible to follow rapid flow changes and that the deflection bore a linear relationship to flow. Twenty years later a greatly improved circuitry and design was described by Denison and Spencer.2 Soon thereafter, a number of investigators, notably Schenk and his colleagues3 utilizing the square wave electromagnetic flowmeter and Cannon and his colleagues4 with the sine wave electromagnetic fiowmeter reported on a number of experimental and clinical studies on blood flow measurements. My introduction to blood flow measurements was through Ferguson5 who had had a flowmeter and flowmeter probes constructed according to the design of Denison and Spencer. Our first report on flow measurements in patients with peripheral arterial disease was made in 1960.6 Electromagnetic flowmeters and probes available today are a vast improvement in ease of use, reliability and accuracy, thus the pertinent question is whether or not the information that can be obtained with it would warrant its routine clinical use. We started with a flowmeter constructed by following a schematic diagram and hand winding our own probes, then to the purchase of Medicon 2000, then Medicon 4000, and to our present unit, the SP2204.* The advancement in instrumentation has been truly remarkable. All intraoperative blood pressure measurements are made with direct arterial puncture with 23 size needle with the hub removed and needle tip fitted to polyethylene tube connected to a strain gauge. Progress has also taken place in other areas of assessment of the circulatory status such as in angiography with selective injections, subtraction studies and in noninvasive diagnostic studies principally with ultrasonic flow detectors, thus the question arises as to whether routine blood flowmeter use would result in duplication of effort and the unnecessary inevitable increase in cost. Our report in 1960 consisted of measurements in one group of patients who had had a lumbar sympathectomy and in another group of patients who had had femoropopliteal bypass procedures. Flow rates not only varied widely but we also observed that repeat measurements made the following day in patients showed that the flows were consistently higher suggesting that a single measurement at the time of operation might be relatively meaningless. This aspect was reported on in greater detail by Renwick and his colleagues.9 After reconstructive surgery, both bypass or endarterectomy in the femoropopliteal area, the electromagnetic flow probe was implanted for periods of 13 to 27 hours in 16 patients and all patients showed increases in blood flow, some as high as four times the intraoperative measurements. The above observations were not without surprise. All vascular surgeons are aware that the blood flow to the extremity is variable and subject to many internal and external stimuli, trauma, and limb exposure, and the obvious increase in circulation to the limb after successful surgery and as the hours pass after completion of surgery. This aspect was particularly well described in a report on hyperemia of reconstructive surgery by Simeone and Husni.10 The increased flow does not persist at the same level but returns to lower levels. Despite these observations we continued to measure blood flows in all our peripheral vascular surgery patients, as well as to study changes in response to drugs, principally papaverine. We were familiar with its intravenous use in acute arterial occlusion,9 and when intra-arterial injection of 10 to 15 mgm. was done, we found that there was almost uniformly an increase in blood flow two to three times the resting flow without significantly provoking a fall in systemic pressure. Flows through bypasses were also observed tO increase after reconstruction had been completed and suggested that abolishing vasomotor tone created a greater physiological runoff and there was merit in a lumbar sympathectomy in conjunction with reconstructive operations. The concept of provoking an increase in flow with papaverine however remained intriguing because we felt that it would be possible to test a segment of the artery as to its ability to respond to increased flow within physiological ranges without an abnormal fall in pressure in the distal segment. On the basis of pressure and flow measurements on 126 patients with aortoiliac and femoropopliteal occlusive disease, the practicality of a hemodynamic test to assess the adequacy or inadequacy of the arterial inlet was suggested in 1966.9 This aspect will be expanded on later in this report because it appears to be one area where intraoperative measurements of flow and pressure may be the most fruitful.


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