Indicator-Dilution Curves

13 Pages·2006·2.71 MB·English

Femoral Artery Flow, Limb Blood Volume and Cardiac
Output Through Continuously Recorded
Indicator-Dilution Curves *
JoHN T. HOBBS,** M.B., B.S., EDWARD A. EDWARDS,* M.D.
FromtheDepartment of Surgery, Peter Bent Brigham Hospital and the Department
of Anatomy, Harvard Medical School, Boston, Massachusetts
THE INDICATOR-DILUTION principle for by means of continuous blood sampling,
measuring blood flow, as introduced by directly writes the indicator concentration-
Stewart and elaborated by Hamilton and time curve.5
his co-workers,7 is now widely used for This continuously recorded curve allows
measuring cardiac output and for evaluat- greater accuracy in the computation of flow
ing cardiac defects.13 It recently has been than that obtained from fractionated sam-
applied to the study ofregional blood flow. ples; its ease of performance allows re-
Organs studied have included the heart,1' peated determinations to be made, as after
the kidneys10,12 and the brain.9 Andres et vasodilatation procedures. Furthermore, be-
al.2 made an extensive study of its possible cause the circulation times are precisely
application to the forearm. recorded, the mean transit time is accu-
The method has since been applied to rately known and the limb blood volume
the measurement of flow in the femoral ar- can be computed. Few values for limb
teryofman; concentration-time curves were blood volume exist, and the present method
obtained by measuring the radio-activity in allows repeated determinations to be made
fractionated samples of blood secured by in studying a changing state.
free flow from the femoral vein, after Cardiac output may be readily measured
sudden injection of radio-iodinated (I131) via the same intravascular needles used for
serum albumin (RISA) into the companion the limb vascular determinations. Finally,
artery.1 Laboratory evaluation of this the computation of total blood volume is
method of measuring femoral artery flow a simple by-product and adds a further di-
in the dog, including simultaneous com- mension to the study.
parison with a mechanical flowmeter, dem- The present paper will describe the
onstrated the validity of the method.4 Re-
method with particular reference to factors
cently, an apparatus was described which, changing the nature of the concentration-
time curves obtained from the femoral
* Submitted for publication September 13,
venous blood. Data will be presented from
1962.
** Assistant in Surgery, Peter Bent Brigham 21 hospital patients studied, some on more
Hospital and Research Fellow in Surgery, Harvard than one occasion. Most of them exhibited
Medical School.
some degree of atherosclerosis. A few prob-
*** Senior Associate in Surgery, Peter Bent
Brigham Hospital and Associate Clinical Professor ably had no structural artery disease, but
of Anatomy, Harvard Medical School. none could be considered healthy individ-
This work was carried out under grants from uals. A total of 59 femoral flow, and 25
The Medical Foundation, Inc., Boston, and the
cardiac output, curves were analyzed.
Massachusetts Heart Association.
159
160 HOBBS AND EDWARDS Annals of Surgery
August 1963
i FIG. 1. Block diagram
ITII of apparatus.
I1,
f
LOW ACKGNUND WELL WASHOUT
SCITILLATION COUTER SOTTLE
Instrument scintillation detector (Tracerlab SC-57A)
and the other end of the helix
The layout of the apparatus is shown in was con-
the block diagram (Fig. 1). The equipment nected to the 50-ml. syringe of the with-
drawal The signal from the scintil-
was conveniently laid out on a mobile trol- pump.
ley. A length of sterile disposable plastic lation detector was passed to a precision
tubing (Baxter, No. R33) connected the ratemeter (Tracerlab SC-79) and the activ-
sampling needle to a helix of plastic tubing ity present in the blood was recorded on
(Abbott Radicoil) via a three-way stop- a rectilinear strip recorder. The third arm
cock. A new connecting tube was used for of the stopcock was connected to a wash-
each determination. The helix was con- out bottle containing 100 mg. of heparin in
tained within the well of a low background 500 ml. of sterile water. This allowed a
L.s.ds, my1,1962
(a)Resting 'I
I -1I W-aIshfIulIIL I tI I 1.:.--1., Ii1:1: 1::
..:. :.:. ...
25K:- I
/rIi
- I I | l-- 1 1
0 I I
10sac:.
50K Rtluh..l)AA.iIIlfrM.ltlw.oII.rLv.Vu.IaIIsn.uog.dgI.Iu.lIV.WA._-- t--4- .-.-. -:.-:..::1±..t-.H::.] ..-:I.-..:,1'..-.11..-.i'1l-i-El:- -:± I*-h- ..I'
.WO,whC-,*..h.tIt ! -L- t
25K- 1~1 -1Ont.!l.%-I-1- F
Lr_A_tI.EtI..E.-.3..:-.'T'.E::...:: '-.-:.. .L. .. =.I' -i '1 I..1. 1
10s.
FIG. 2. Events noted in indicator-dilution curves recorded from femoral venous blood after
injection of RISA in femoral artery of patient with arteriosclerosis, 13 months after lumbar
sympathectomy. Femoral pulse was small, popliteal absent, and a small posterior tibial pulse
could be felt. Curves are characteristic of low flow. The femoral artery flow calculated from
curve a was 287 ml./min. Flow calculated from curve b, after the intra-arterial injection of 25
mg. Ilidar, was 344 ml./min.
Volume 158 FEMORAL ARTERY FLOW AND CARDIAC OUTPUT 161
Number 2
washout of the helix and its connecting drawn through the helix and a plateau of
tubes by the withdrawal immedi- activity was recorded (Fig. 5).
pump,
ately after a curve had been written. A Obtaining the Cardiac Output Curve.
single of 15 ml. of the washout The cardiac output was the first determina-
passage
solution restored the background of the tion done in each study, thus taking advan-
helix to its original level (Fig. 2). tage of the initial low blood background.
To obtain this dilution curve, 20 pc (2.0
Method
ml.) RISA was injected into the femoral
A. Procedure
vein and the concentration-time curve ob-
Preparation of the Patient and of the tained from the femoral artery blood sam-
Injectate. The study was made in an air- ple. A longer appearance time was seen,
conditioned room and the ambient temper- but the peak concentration was much
ature recorded. After the patient was ex-
amined, the limb volume determined
was E.f. g24, March8,1962
by displacement of small plastic pellets 90K I(i.Rs.lr.. iIlil;.el- TIj:;lItJzIIEpAIL1VtI H' Illf1-.tlll-.Il*-l : 1:1p
from a suitable cylinder. The patient then _- i* T1| E 1!1"tt rMtt111l! :11i
assumed the supine position and the leg 1i l: '"',
6OK44"'
adjusted until the tibia horizontal . -1 tlifl. 11I
was was
at the level of the heart; slight abduction j4
and lateral rotation facilitated puncture of '4 30K U N:IM.t.itItIr NIt.
the femoral vein. A bleb of local anesthetic
(1.0% xylocaine) was placed over each of 10an.
the femoral vessels. An 18-gauge Cournand
needle was then placed upstream in the m.H. 51. Feb 13,1962
common femoral artery and a three-inch 300K-h)Resting- I-_OOK
18-gauge spinal needle was placed in the
companion vein. Twentymilligrams of hep-
arin was then given intravenously. The
sampling apparatus was filled with the hep- 150 - 50K
arin washout solution and all air was ex-
cluded from the helix and withdrawal
syringe.
The indicator was prepared by making 7
a solution of radioiodinated serum albumin (cjReactlveHyperemle
which contained 100 ,uc in 10 ml. of iso-
tonic saline. The injecting syringe was
loaded with RISA and connected to the
arterial needle for the limb flow test or to 90K- - 1 R.t
the venous needle for cardiac output. The
extensiontubefromthehelixwas connected
'7.5"
to the second needle. Withdrawal of blood Zadfon6 2_moth prio to test1. iFlo inaf
was begun at a rate of 15.3 ml./min.; the FIG. 3. Curves recorded from femoral venous
injection was then made and a curve bpaltoioedntasftweirtihnoturta-aertveirdieanlceinjoefctiaornteroifosRclIeSroAsiis.n tPwao-
drawn. After all determinations had been tient shown in a had been hospitalized for 3
made, a standard solution was prepared mgoanftthsdofnoer 2fYr2actmuornethosf sphraifotrotfo fteesmtu.r,Flwoiwthinboanfe-
by injecting the same dose (10 Muc in 1.0 fected limb was 278 ml./min. Patient shown in b
suffered from arthritis and chronic vasospasm.
ml.) through the same syringe and needle Resting flow was 149 ml./min.; during reactive
into a liter of water. This solution was then hyperemia it was 309 ml./min.
162 HOBBS AND EDWARDS Annals of Surgery
August 1963
FIG. 4a. Methacrylate
cast of arterial tree of
this limb. Note richness
of thigh vasculature and
'b.) paucity of arteries of leg
and foot. b. Curve re-
,^^0oo corded from femoral ve-
32kg. DOG nous blood of a dog after
intra-arterial injection of
Dec.21,1961 L t2440,000 RISA.
I w
femoral ortery . F--
flow- 195 ml/min. ._. ...... ^.. ..... OZ
F...
L--. - I 1 2
.__I.-_,S........ o __loa w _ I ---.._I.z...._.__..........-.... 20,000w
11.77-
.... ........ I I--.........
0,000
z
0LL
7.5
sec.
sharper than for limb flow. The sensitivity by the dead space of the system. This con-
of the system was indicated by the pres- stant latent period was determined and the
ence of stepwise pulsatile changes in the appearancetimewasthus corrected. Within
curve (Fig. 7). As soon as an adequate 30 seconds of its appearance the activity
downslope was recorded the system was built up rapidly to the sharp peak of the
washed out, by switching the three-way primary circulation and then fell exponen-
stopcock so that heparin solution was tialy until recirculation of the peak con-
drawn from the washout bottle. This re- centration occurred. To evaluate the limb's
stored the helix background to its original blood supply further, an attempt was made
level. to increase the blood flow by reactive hy-
Obtaining the Femoral Artery Flow peremia. A narrow cuff was placed imme-
Curves. Blood was withdrawn from the diately above the knee joint, intentionally
femoral vein at a constant rate of 15.3 ml./ excluding the bulk of the thigh. The cuff
min. and, as it passed through the helix, was inflated to 20 mm. Hg above systolic
the level of background activity was re- pressure and maintained for three minutes.
corded. One milliliter (10 ,uc) of RISA was About a minute after its release, when con-
rapidly injected into the femoral artery and ditions were judged to be stable, a dilution
a mark made on the chart. The appearance curve was made by repeating the injection
of activity in the femoral vein was delayed of RISA into the femoral artery.
Volume 158 FEMORAL ARTERY FLOW AND CARDIAC OUTPUT 163
Number 2
In a few patients, particularly those in R.S.* 67, MCrch6, 1962
(_.)Rest* ngn
whom the application of cuff consid-
a was
ered hazardous, vasodilatation was at- L_.; IL.*
tempted by the injection of25 mg. of either i.'..I.. ''_- _
PIrnistchoeline or IolfidaPrri*scionltionet,herfeedmdoernailnagrtearnyd. 11I4. 1J . I+
case 45K-
goose-pimpling demonstrated the of
area
the injection. When the effect appeared
maximal and stable (usually five minutes),
a further injection of RISA was made into
the femoral artery and another dilution 0 10
sec.
curve recorded. (b.)Standard
Because the instantly
curves were seen,
technical fault unusual result
any or was
immediately known and the
curve was re-
peated. This corroborated atypical findings
and avoided irrevocable losses, as some-
times occurred with previous fractionator 0
sampling method. 10sec.
FIG. 5a. Curve recorded from femoral venous
B. Calculations blood after intra-arterial injection of RISA in an
arteriosclerotic woman, with occlusion of super-
Blood Volume. Ten minutes was allowed friecliaatlivfeelmyorraalpiadnddecploipnlei,tewalitahrterireess.ulSthaanrtphirigshe acanld-
for equilibrium to become established be- culated femoral artery flow oaf 503 ml./min., are
tween each injection. The background level all unusual in arteriosclerosis and are attributed to
open arteriovenous communications visible in fem-
of activity depended on the dilution of the oral arteriogram. b. Representative curve of stand-
previous injectate in thetotalblood volume. ard. After it fills helix, a plateau is reached.
Total blood volume (TBV) was derived
from the standard dilution equation:
E.L.dsi. msrehIo.I
'OK.
TBV= B-
B2 - B1 Zas
where Ii activity of standard solution
= X
volume of injectate x 1,000; B2= back-
ground activity of blood withdrawn after
equilibrium period; and B1 = background
'Os..
activitybefore theinjection was made (Fig.
2). Usually three such determinations were
made in each patient study.
Circulation Times. Because the sampling 355.
was at a constant rate and the delay of
the system was exactly known, accurate * I06 . --_
circulation times were recorded in seconds. FIG. 6. Characteristic slow decline of activity
Recirculation of the limb flow was esti- in femoral venous blood after intra-arterial injec-
mated as femoral vein to femoral artery wtiiotnh ocfhaRnIgSeAtoiwnaradsaevnereealryliearrtedroiwonscslleoropteicdulriimnb,g
time (from cardiac output curve), plus two reactive hyperemia. Femoral pulse was lowest
times femoral artery to femoral vein time. psaylmppaabtlhe.ectEoxmaym.inaCtailocnulawtaesd dfolonwe i2n mroensttihnsg asfttaetre
was 276 ml./min. (repeated at 236). Reactive hy-
* Kindly supplied by the Roche Laboratories. peremia raised flow to 333 ml./min.
164 Annals of Surgery
HOBBS AND EDWARDS August 1963
This is shown diagrammatically at the top lowed the downslope of the primary circu-
of Table 1. The estimated recirculation lation to be extrapolated to zero. The con-
time was marked on the chart and was in centration of activity at suitable timne inter-
close agreement with the point at which vals was taken from the curve. Flow was
the downslope broke away to the right on then calculated usingthe standard formula:
the semilogarithmic plot. F=I X 1 000X60
Calculation of Flow from Dilution
Curves. The dilution curve was redrawn on where F= blood flow in ml./min.; I = ac-
semilogarithmic graph paper and this al- tivity of standard x volume of injectate;
FIG. 7. Curves re-
corded in a patient with
arteriosclerotic occlusion
below the common fern-
oral artery, with concom-
itant marked atrophy of
the thigh muscles due to
sugcal ankylosis of the
knee produced in child-
hood. a. The Limb. b.
Curve recorded from the
femoral arterial blood
after intravenous injec-
tion of RISA. Cardiac
output computed from
this curve was 4,371 ml./
MM. c, d, e and f. Con-
centration curves from
the femoral venous blood
after intra-arterial injec-
tion of RISA. Femoral
artery flow was 180, 268,
575 and 253 ml./min.,
respectively.
Volume 158 FEMORAL ARTERY FLOW AND CARDIAC OUTPUT 165
Number 2
1,000 is the dilution of the standard; sc = where sC = sum of the concentration at
sum of concentrations at regular intervals; suitable time intervals (C1 + C2 + C3,
and t = this time interval in seconds. This etc.); sct = sum of each of these concen-
procedure is the same for both femoral trations x sample number (Cl x 1 + C2 x
artery flow and cardiac output. 2 + C3 x 3, etc.); and t = time interval in
Mean Transit Time, Limb Blood Volume seconds.
and Volume Distribution Index. Because The effective limb blood volume (LBV)
the time events of the indicator-dilution is the volume between the sites of injection
accurately known, the and sampling, and deduced from the
curves were mean was
transit time (MTT) of the primary circula- formula:
tion in the limb was calculated from the MTT X BF
standard formula: 60
LBV=
where LBV limb blood vol. in ml.; MTT
=
MTT = sctscX t+appearancetime, = mean transit time in seconds; and BF =
TABLE 1. Circulation TimesDerivedfrom Concentration-time Curves.
(Expressedinseconds4istandarddeviation)
Limb Cardiac Limb
Primary Output Recirculation
Circulation (24) Estimated*
_LUNGS_ _ LUNGS
LEFT RIGHT LEFT RIGHT
HEART HEART HEART HEART
AA V\N
A4 V A
Restingfemoralartery (37 tests)
Appearance:
Mean 3.1 4 1.54 12.2 i3.39 c. 29
Range (1-7) (8-20)
Peak Concentration:
Mean 35.5 :1 16.45 22.84 3.91 c. 62
Range (9-91) (18-33)
Withreactivehyperemia (15 tests)
Appearance:
Mean 1.641 1.32 c. 26
Range (1-5)
Peak Concentration:
Mean 26.2 it 10.51 - c. 51
Range (9-42)
Withpharmacological vasodilatation (7 tests)
Appearance:
Mean 1.64 0.73 c.26
Range (1-3)
Peak Concentration:
Mean 21.74i 13.22 c. 47
Range (8-50)
*Recirculation times have been estimated as follows: Recirculation of appearance = 2 X appearance of pri-
mary+peakofcardiacoutput. Recirculationofpeakconcentration = appearanceofprimary +peakof primary
+peak ofcardiacoutput.
166 HOBBS AND EDWARDS Annals of Surgery
August 1963
TABLE 2. CardiacOutput, Tota Blood VolumeandFemoralArtery Flow
Cardiac FemoralArteryFlow
Age, Limb TBV Output (ml./min.) FemoralFlowas:
Pt. Sex Limb Vol. (ml.) (ml./min.) RH Vd. %LV %TBV % CO
Minimalornoarteriosclerosis
1. 51, F Lt. 8,640 3,778 3,279 180 309 354 2.08 4.75 5.48
2. 32,F Rt. 6,990 3,275 - 189 471 - 2.70 5.77 -
3. 24, F Rt. 7,710 3,914 4,002 277 434 - 3.59 7.07 6.92
4. 51, M Rt. 8,825 5,470 3,641 386 - - 4.37 7.05 10.60
5. 42, M Lt. 9,860 6,026 5,584 484 544 602 4.90 8.03 8.66
6. 72, M Lt. - 4,932 6,269 480 - - - 9.73 7.65
Moderate arteriosclerosis
7. 74, M Rt. 8,645 4,754 3,772 235 304 - 2.71 4.94 6.23
8. 54, M Rt. 7,400 5,344 4,371 187 268 575 2.52 3.49 4.27
8. (postop.) Rt. 7,400 5,158 5,340 253 - 584 3.41 4.90 4.73
9. 51, M Lt. 6,440 4,157 4,332 276 333 - 4,28 6.64 6.36
10. 58, M Rt. 6,050 5,884 4,352 310 369 - 5.12 5.62 7.12
11. 65, M Lt. 7,160 5,147 4,704 256 488 - 3.57 4.72 5.41
4,789
12. 73, M Rt. 10,860 5,437 - 304 - - 2.71 5.59 -
12. (postop.) Rt. 10,860 5,208 - 289 - - 2.66 5.54 -
13. 64, M Lt. 9,120 5,630 5,490 492 - - 5.39 8.73 8.96
14. 76, M Lt. 10,810 6,636 5,353 - 359 - (3.32) (5.61) (6.70)
Severedistalarteriosclerosis
15. 72, F Lt. 5,970 3,600 3,356 180 - - 3.01 5.00 5.36
16. 47, M Lt. 6,100 4,277 2,878 187 203 336 3.05 4.37 6.49
17. 48, M Lt. 10,400 6,085 5,122 328 346 - 3.15 5.39 6.40
18. 62,F Rt. 7,170 3,560 3,882 207 228 - 2.88 5.65 5.33
*19. 67, F Lt. 7,190 3,370 5,134 503 - - 7.40 14.82 9.79
*20. 57, M Lt. 9,580 6,609 5,259 563 677 672 5.87 9.27 10.70
Lowthighamputationstump
21. 66, F Rt. 6,800 5,225 3,360 305 - - 4.48 5.83 9.08
TBV =Total BloodVolume.
LV =LimbVolume (ml).
CO =CardiacOutput (ml/min).
RH =Reactive Hyperemia.
Vd. =PharmacologicalVasodilatation.
Post-op-Referstolumbarsympathectomy.
*Arteriovenousshuntinginthethighwasdemonstrated,arteriographicallyinCase 19andsuspectedinCase20.
blood flow in ml./min. The limb blood vol- Results
ume was then expressed as a percentage A. Cardiac Output and Femoral Artery
of limb volume or of total blood volume. Flow
In an attempt to correlate findings amongst The concentration-time curves for the
different patients, LBV was related to limb cardiac output determinations showed sharp
volume, total blood volume and total body
contours, with structure due to the
mass in the expression, volume distribution arterial pulsation; and with disappearance
index (VDI of Karpeles and Huff6), the
slopes, which, when plotted on semiloga-
formula being: rithmic the desired clear
paper, gave ex-
ponential decline of the primary circulation
VDI TBLVBBaVs %%totlalimbbovdoyl.wt. (Fig. 7b). The values obtained are shown
in Table 2, which also summarizes the
total bloodvol. in body (ml.) X 100 blood volume and femoral flow values.
bodywt. (Gm.)
bloodinlimb (ml.) X 100 The curves for femoral flow showed the
vol.
vol. oflimb (ml.) same clear results when conditions were
Volume 158 FEMORAL ARTERY FLOIwv.AND CARDIAC OUTPUT 167
Number 2
relatively normal (Fig. 3). Such favorable the curve has substantially declined. As re-
curves depend upon: tardation of the blood stream becomes ex-
treme, events may be so delayed that the
1. A normal distribution of tissue mass and
exponential decline, essential to the method,
vascular bed between the thigh, from which much
blood and indicator reach the sampling site rap- is not clear-cut (Fig. 8b) or cannot be
idly, and the leg and foot, whose smaller fraction
of blood and indicator must traverse longer cir-
cuits to reach the femoral vein. WRositla dm.1i4. atchao,*6s
.
2. Baseduponthesefactors, a circulation which
is not too sluggish.
The importance of the first factor is illus-
trated by conditions in the normal dog and
in some of our patients. Previously pub- O -110se.
lished indicator-dilution curves from the mu A79 uM.um.L
40K(biRs
femoral vein of the dog4 are somewhat
20K-
sharper than those from normal human
0
subjects. This would appear to be based
upon the exaggerated proximal preponder-
ance of tissue mass and vascular bed in the _I:AL....5s...5....fi
thigh, versus the leg and foot, in this ani-
mal (Fig. 4). Curves resembling the ca- li_tRealm Lo.qGa. ifty11.1962
nine, with unusually rapid appearance and
peak concentration times, were obtained in
one of our arteriosclerotic patients whose 0 -
arteriogram showed arteriovenous shunting
in the thigh. (Fig. 5). The converse result
was seen in another arteriosclerotic patient
whose thigh was exceptionally atrophied
due to surgical ankylosis of the knee per-
foArmeddelianychinildahpopoedar(aFnicge. 7t)i.me and peak 240KS_wfttl"Cit.?M April3.1942
build-up of indicator is seen in conditions
of greatly retarded blood flow (Fig. 2, 6).
In such cases, recirculation may appear be-
0I
fore the exponential decline is clearly es-
tablished. However, the error thus intro- FIG. 8. Indicator-dilution curves from femoral
duced is small (less than 5.0%), since this venous blood in patients with a variety of vas-
cular problems. a. Patient with claudication, but
recirculated indicator has not acquired palpable distal pulses. Aortogram showed mod-
peak concentration and has been diluted erate narrowing of iliac arteries. Femoral artery
flow was 235 ml./min. b and c. Patient with early
by the general blood volume, with only a congestive heart failure and femoro-popliteal artery
fraction of even that diluted material re- occlusion. Resting flow was 359 ml./min., but cal-
culations from this curve may not be accurate.
turning to the limb. This quantum of re- Curve in reactive hyperemia was more satisfactory,
circulated indicator is very little when with a flow of 418 ml./min. d. Thigh stump 10
days after supracondylar amputation. Flow of 288
compared to the high concentration in the ml./min. was high, but we have found relatively
femoral venous blood while the curve is high flows in these stumps. e. Patient with arrested
thrombo-angiitis obliterans with loss of pedal
still elevated. The recirculated indicator is, pulses, but no other signs of ischemia. Flow was
of course, very evident as a breakaway 328 ml./min. f. Diabetic patient with no pulses
palpable below femoral and with old healed trans-
from the downslope, when it occurs after metatarsal amputation. Flow was 200 ml./min.
168 HOBBS AND EDWARDS Annals of Surgery
August 1963
TABLE 3.Mean Transit Time andLimb Blood Volume
TBV
as %
MTT LBV LBVas%of of
(sec.) (ml.) LBVas % ofTBV LimbVol. Body
Pt. RH Vd. RH Vd. RH Vd. RH Vd. Wt. VDI
Minimalornoarteriosclerosis
1. 58 61 56 174 314 330 4.9 7.1 7.4 2.0 3.6 3.8 5.8 2.90
2. 84 33 - 264 259 - 8.1 7.9 - 3.8 3.7 - 8.8 2.31
3. 59 52 - 273 376 - 7.0 9.6 - 3.6 4.9 - 8.5 2.36
4. 59 - - 370 - - 6.7 - - 4.2 - - 9.3 2.21
5. 60 37 35 484 335 351 8.0 5.5 5.8 5.0 3.4 3.5 8.2 1.64
6. 66 - - 524 - - 10.6 - - - - - 6.2 -
Moderatearteriosclerosis
7. 80 84 - 313 425 - 6.6 8.9 - 3.6 4.9 - 7.3 2.01
8. 112 60 36 348 268 345 6.5 5.2 6.4 4.7 3.6 4.7 7.7 1.64
8. 87 - 31 376 - 291 7.3 - 5.6 5.0 - 4.0 7.4 1.48
9. 100 75 - 460 416 - 11.6 10.0 - 7.1 6.5 - 7.4 1.04
10. 91 107 - 470 659 - 7.9 11.2 - 7.7 10.9 - 6.8 0.88
11. 111 73 - 473 593 - 9.1 10.9 - 6.0 8.2 - 8.3 1.38
12. 116 - - 586 - - 10.8 - - 5.4 - - 6.4 1.18
12. 130 - - 626 - - 12.0 - - 5.9 - - 6.2 1.05
13. 71 - - 582 - - 10.3 - - 6.3 - - 7.8 1.24
14. 100 - - 598 - - 9.1 - - 5.5 - - 8.1 1.47
Severedistalarteriosclerosis
15. 58 - - 174 - - 4.8 - - 3.0 - - 6.7 2.23
16. 74 75 69 230 253 386 5.4 - - 3.8 4.2 6.4 7.6 2.00
17. 47 50 - 256 288 - 4.2 - - 2.4 2.8 - 7.8 3.25
18. 82 38 - 279 144 - 7.5 - - 3.9 2.C - 7.9 2.02
*19. 43 - - 360 - - 10.7 - - 5.0 - - 5.0 1.00
*20. 78 55 57 732 620 640 12.0 10.2 10.5 7.6 6.5 6.6 8.6 1.13
Lowthighamputationstump
21. 69 - - 350 - - 6.1 - - 5.1 - - 7.4 1.45
MTT =MeanTransitTime (sec.),femoralarterytofermoralvein.
LBV =Volumeof BloodinLimb (ml.),from MTT Xbloodflow.
TBV =Total BloodVolume (ml.).
vol.ofbloodinlimb (ml.) X100
LBVas % ofLimbVolume = vol.oflimb (ml.)
totalbloodvol.inbody X100
TBVas % of BodyWeight = bodywt. (Gm.)
TBVas %oftotalbodywt.
VDI =Volume Distribution Index = LBVas %oflimbvol.
RH =ReactiveHyperemia
Vd. =PharmacologicalVasodilatation
*Arteriovenous shuntinginthethighwasdemonstrated inCase 19andsuspected in Case20.
demonstrated. While in such cases we flow (Table 2). Limb blood volume was
could not compute the resting blood flow, also increased (Table 3). These changes
the institution of some vasodilatation usu- were either less or failed to occur in the
ally yielded a usable curve, granted that presence of arteriosclerosis (Table 1-3), a
the flow value thus obtained must be com- result similar to that seen when a pulse
pared with flow under vasodilatation in registration was used to record reactive
other subjects. hyperemia.3
As noted, changes in the curves induced
B. Effect of Vasodilatation by vasodilatation sometimes allowed a flow
Both reactive hyperemia after cuff ap- computation which could not be achieved
plication and vasodilatation after intra-ar- from the curves in the resting state (Fig.
terial drug injection gave curves with a 8b, c).
more rapid time sequence (Table 1; Fig. The injection of Priscoline caused the
3c, 6c, 7d, 7e, 8c) and with increases in whole limb to blush and become goose-
flow, up to 150 per cent above the resting pimpled; the blush included a little of the