Direct arterial pressure measurements during operation to assess adequacy of arterial reconstruction in lower limb ischaemia

Over a 3-year period 164 patients undergoing arterial reconstruction for lower limb ischaemia had direct arterial pressure measurements during the operation. The arterial pressure was measured by direct puncture of the vessel with a No. 23 gauge needle connected, via a cannula, to a pressure transducer. The pressure was measured proximal and distal to anastomoses or endarterectomies, and note was made both of the absolute pressure and waveform. At 3 months 95 per cent were patent. In nine patients (5 per cent), there was a significant fall of pressure across the reconstructed artery and in eight of these procedures were carried out to correct the fault. The technique of direct arterial pressure measurement is quick and easy to perform, with equipment that is used routinely for monitoring by the anaesthetist. There has been no evidence of damage due to the arterial puncture itself. It provides a simple, objective assessment of adequacy of an arterial reconstruction and may lead to the early correction of otherwise unrecognized faults, and thus prevent early graft occlusion.