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Research article

Arterial waves in humans during peripheral vascular surgery

Ashraf W. KHIR, Michael Y. HENEIN, Tat KOH, Saroj K. DAS, Kim H. PARKER, Derek G. GIBSON
Clinical Science Dec 01, 2001, 101 (6) 749-757; DOI: 10.1042/cs1010749
Ashraf W. KHIR
Physiological Flow Study Group, Department of Bioengineering, Imperial College of Science, Technology and Medicine, Prince Consort Rd., London SW7 2BY, U.K.
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  • For correspondence: a.khir@ic.ac.uk
Michael Y. HENEIN
Echocardiography Department, Royal Brompton Hospital, Sydney St., London SW3 6NP, U.K.
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Tat KOH
Echocardiography Department, Royal Brompton Hospital, Sydney St., London SW3 6NP, U.K.
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Saroj K. DAS
Vascular Surgery Department, Hillingdon Hospital, Pield Heath Road, Hillingdon, Uxbridge, Middlesex UB8 3NN, U.K.
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Kim H. PARKER
Physiological Flow Study Group, Department of Bioengineering, Imperial College of Science, Technology and Medicine, Prince Consort Rd., London SW7 2BY, U.K.
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Derek G. GIBSON
Echocardiography Department, Royal Brompton Hospital, Sydney St., London SW3 6NP, U.K.
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Abstract

The purpose of this study was to investigate the effect of aortic clamping on arterial waves during peripheral vascular surgery. We measured pressure and velocity simultaneously in the ascending aorta, in ten patients (70±5 years) with aortic-iliac disease intra-operatively. Pressure was measured using a catheter tip manometer, and velocity was measured using Doppler ultrasound. Data were collected before aortic clamping, during aortic clamping and after unclamping. Hydraulic work in the aortic root was calculated from the measured data, the reflected waves were determined by wave-intensity analysis and wave speed was determined by the PU-loop (pressure-velocity-loop) method; a new technique based on the ‘water-hammer’ equation. The wave speed is approx. 32% (P < 0.05) higher during clamping than before clamping. Although the peak intensity of the reflected wave does not alter with clamping, it arrives 30ms (P < 0.05) earlier and its duration is 25% (P < 0.05) longer than before clamping. During clamping, left ventricule (LV) hydraulic systolic work and the energy carried by the reflected wave increased by 27% (P < 0.05) and 20% (P < 0.05) respectively, compared with before clamping. The higher wave speed during clamping explains the earlier arrival of the reflected waves suggesting an increase in the afterload, since the LV has to overcome earlier reflected compression waves. The longer duration of the reflected wave during clamping is associated with an increase in the total energy carried by the wave, which causes an increase in hydraulic work. Increased hydraulic work during clamping may increase LV oxygen consumption, provoke myocardial ischaemia and hence contribute to the intra-operative impairment of LV function known in patients with peripheral vascular disease.

  • aortic clamping
  • haemodynamics
  • reflected waves
  • wave intensity.
  • The Biochemical Society and the Medical Research Society © 2001
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December 2001

Volume: 101 Issue: 6

Clinical Science: 101 (6)
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Arterial waves in humans during peripheral vascular surgery
Ashraf W. KHIR, Michael Y. HENEIN, Tat KOH, Saroj K. DAS, Kim H. PARKER, Derek G. GIBSON
Clinical Science Dec 2001, 101 (6) 749-757; DOI: 10.1042/cs1010749
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Arterial waves in humans during peripheral vascular surgery
Ashraf W. KHIR, Michael Y. HENEIN, Tat KOH, Saroj K. DAS, Kim H. PARKER, Derek G. GIBSON
Clinical Science Dec 2001, 101 (6) 749-757; DOI: 10.1042/cs1010749

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Keywords

aortic clamping
haemodynamics
reflected waves
wave intensity.

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