1. No category

Research
Transplant Surgery
Reduce Allograft Risk
with Intraoperative Flow
Measurements
•
Identify Impaired Blood Flow before Closure
•
Assess Flow Quickly and Quantitatively
•
Document Restored Flow
Research
Transplant Surgery
Intraoperative Measurements Inform
during Transplantation Surgery
Lifesaving transplant surgeries challenge
a transplant surgical team to perform
at their highest level. During these high
stake surgeries, intraoperative blood flow
measurements provide quick, quantitative
assessments of blood flow that may either
confirm a clinical impression or alert the
team to potential problems while they still
can be more easily addressed.
Orthotopic liver transplantation, in
particular, presents a unique opportunity
for intraoperative flow measurements.
Measurements are incorporated into the
protocol for the multicenter Adult-to-Adult
Living Donor Liver Transplantation (A2ALL)
study. Since simple visualization of a pinkto-red reperfused liver doesn’t ensure that
both the hepatic artery and portal vein are
each functioning, simultaneous hepatic/
portal measurements provide an essential
quality assurance.
In addition to checking the quality of
anastomoses in liver, renal, pancreatic,
lung and heart transplant surgeries,
intraoperative measurements also identify
potential kinking of conduits, particularly
veins, and are useful in identifying
donor-to-recipient mismatches. No other
flow technology produces flow data as
quickly, accurately and non-intrusively
during transplant surgery as Transonic®
intraoperative flow measurements.
”We used Flowprobes to evaluate flows in the hepatic artery and portal
vein in the setting of living donor liver transplantation. This formal process
allowed us the evaluate the impact of flows on eventual graft function and
correlate with risk factors for graft failure.”
Emond, J, MD, Chief of Transplantation, Columbia Presbyterian Medical Center,
Co-chair, A2ALL Study.
“The routine use of intraoperative flow measurements of the hepatic
artery may be a useful adjunct in identifying the hepatic artery reconstruction, which is at risk of subsequent hepatic arterial thrombosis (HAT).”
Lin M et al, “Hepatic Artery Thrombosis and Intraoperative Hepatic Artery Flow
Rates in Adult Orthotopic Liver Transplantation, ANZ J Surg 2002; 72: 798-800.
“Impaired hepatic arterial blood flow after reperfusion along with primary
non-functioning organ (PNF) are significant predictors of increased
graft injury and is associated with diminished long-term graft survival.
...Intraoperative transit time ultrasound flow measurements of the hepatic
artery may allow identification of organ transplants at risk for poor
outcomes. ...Hepatic arterial flow < 100 ml/min presents a significant risk
on organ survival.”
Pratschke S et al, “Arterial Blood Flow Predicts Graft Survival in Liver Transplant
Patients,” Liver Transplantation 2011; 17: 436-445.
TRANSIT-TIME ULTRASOUND TECHNOLOGY
MEASURES VOLUME FLOW, NOT VELOCITY
Two transducers pass ultrasonic signals, alternately intersecting
the vessel in upstream and downstream directions. The difference
between the two transit times yields a measure of volume flow.
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 205
6181 MB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 04-2946-8541
Fax: +81 04-2946-8542
[email protected]
TransplantCover(TX-500-fly) Rev. A 4-13
Transplant Surgery
Flowprobes for Transplant Surgery
Transonic® Flowprobes work with HT300-Series-FT Flowmeters to measure volume flow in blood
vessels and grafts from 0.5 to 36.0 mm. The measurement of flow in vessels during transplant
procedures can guide surgical decisions. The ability to correct otherwise undetectable flow
restrictions provides the surgeon with an opportunity to improve the outcome for the patient.
Probe body
Flexible neck
Handle
Reflector
Fig. 1: 4 and 6 mm Vascular Flowprobes recommended for measuring hepatic arterial flow. Picture shows Flowprobe handle
with size of Probe in mm, the Probe’s flexible neck for optimal positioning of the Probe around the vessel, the Probe
body that houses the ultrasonic transducers, and the Probe reflector. Vessel is positioned within the Probe sensing
window that is defined by the Probe body and its stationary reflector.
Fig. 2: 8 mm, 10 mm, 12 mm and 14 mm Vascular Flowprobes recommended for measuring portal venous flow.
FLOWPROBES: TRANSPLANT SURGERY
LIVER
Probe Size (mm)
Probe Series
hepatic artery
4, 6
FMV
portal vein
10, 12, 14
FMV, -AU
ascending aorta
4, 6
FMV, -FSB
pulmonary artery
10
FMV, -FSB
8
FMV, -FSB
KIDNEY
PANCREAS
common iliac artery
TXFlowmetersFlowprobes (TX-501-ds)RevA 6-13
Flowmeters for Transplant Surgery
Transonic’s new Optima Flow-QC® Flowmeter takes
transit-time ultrasound flow measurement resolution to
the highest level. The Optima’s unprecedented resolution
accompanies lower offsets, and doubles the accuracy for
low flows.
The Optima Flowmeter enables use of the entire line of
resterilizable Flowprobes for liver, renal, heart, lung and
pancreas transplants. Flowprobe sizes range from 0.7 mm
to 36 mm. The flexible neck of handle Flowprobes permits
optimal Probe positioning for measurement ease.
• Provides unsurpassed accuracy
• Ensures vessel patency
• Immediate, quantitative flow measurements
HT354 Single-channel Optima Flowmeter for measuring flow of one
vessel during transplantation procedures.
The AureFlo® is a versatile system used to
continuously measure, display, and record absolute
volume flow and other derived parameters. Shown
here with the new HT364 dual-channel Optima
Flowmeter, it can be used with Transonic’s extensive
line of Flowprobes for every application.
HT364 Dual-channel Optima Flowmeter permits simultaneous
measurements with two Flowprobes, particularly useful for
measuring hepatic arterial and portal venous flows during liver
transplantation.
www.transonic.com
Liver Transplant
Medical Note
Intraoperative Blood Flow
Measurement during Adult
Orthotopic Liver Transplantation
Courtesy of J. Michael Henderson, M.D., F.A.C.S.
Introduction
Abnormal hepatic hemodynamics and physiology in
the transplanted liver pose continuing challenges
for the surgeon. A practical method for measuring
two of these hemodynamic parameters, portal
venous and hepatic arterial flows, is by intraoperative flow measurements. Transit-time ultrasound
technology is well suited to measure these flows.
Flowprobes are easily applied and do not have to
be applied tightly to vessels; they simply encompass
the vessel.
Surgical Approach
Measurement of portal venous and hepatic arterial
flows can be easily done at the completion of
orthotopic liver transplantation using Transonic
Flowprobes. Following completion of the vascular
anastomoses, the new liver is reperfused, and
hemostasis achieved. Prior to biliary reconstruction,
the Flowprobes are placed on the reconstructed
portal vein and hepatic artery.
The Probes are chosen to comfortably encompass
- but not constrict - the vessels, and are placed
such that extraneous tissue is excluded. The field
is then immersed in saline which serves as a good
acoustic contact with the vessels. Readings stabilize
rapidly, usually within 1-2 minutes, and in stable
patients fluctuate less than ± 10% when left in situ
for 10-15 minutes. If there is wider fluctuation,
this usually indicates improper positioning of the
Flowprobes with poor alignment or extraneous
tissue, and can normally be corrected by repositioning. Arterial flow readings are meaningful over
a brief snapshot period. Venous flow exhibits a far
slower rhythm, dictated by events such as gastric
motility. A one-to-five minute observation period is
often adequate.
LiverTransplantMedicalNote(TX-503-mn)Rev E 2013
Discussion
Combined portal venous and hepatic artery
flow are usually 15 - 25% of cardiac output. Of
clinical importance is hepatic artery patency
and flow, as survival of the graft depends on
this. Flowprobes provide a volumetric measure
of hepatic artery flow, and when this is low
can be used to determine if there is a fixed
anatomic limitation to flow or a physiologic
limitation. For example, in a patient with a
cardiac output of 10 L/min, portal flow of
2000 ml/min and hepatic artery flow of 75
ml/min, reduction of portal flow to 1000 ml/
min resulted in a hepatic artery flow increase
to 125 ml/min. Thus, the low basal hepatic
artery flow resulted from a high physiologic
resistance rather than a fixed, potentially
surgically correctable low inflow. This kind of
data can be collected on the flowmeter’s strip
chart recorder for a permanent record.
The information obtained with these
transit-time ultrasound Flowprobes is often
at variance with “clinical impression.” A
transplant with obstructed hepatic artery may
show a strong pressure pulse on the artery,
and a healthy organ color due to its venous
perfusion. Accurate information on volumetric
flow at the time of operation can either be
reassuring, or may indicate an unexpected
problem which can be fixed at this time.
Intraoperative Blood Flow Measurements
F l o w - A s s i s t e d
L i v e r
References
LIVER HEMODYNAMICS
TRANSPLANTED LIVER (N = 34)1
Vessel
Flow: Mean ± SD (L/mm)
Tr a n s p l a n t a t i o n
Range
Total Liver
2.091 ± .932
.570 - 4.540
Portal vein
1.808 ± .929
.300 - 4.500
Hepatic artery
0.268 ± 157
0.30 - 0.675
In a procedure such as liver transplant, where the
stakes are high, this technology can be a useful
adjunct in operative decision. Subsequent studies
have identified the following intraoperative flow
indices related to poor outcomes:
• Poor outcome is associated with graft hyperfusion. Recipient portal venous flow in the recipient should be lowered when graft to recipient
body weight ratio (GRBWR) < 0.8 is accompanied by portal inflow of > 250 mL/min/100g
graft weight.3
• Hepatic arterial flow < 100 mL/min presents a
significant risk on organ survival.4
• Hepatic artery flows of less than 200 mL/min
following orthotopic liver transplantation
increase the risk of subsequent hepatic artery
thrombosis six times.5
1Henderson JM et al, “Hemodynamics During Liver Transplantation: The
Interactions Between Cardiac Output and Portal Venous and Hepatic
Arterial Flows,” Hepatology 1992; 16(3): 715-718.
2Henderson JM et al, Volumetric and Functional Liver Blood Flow Are
Both Increased in the Human Transplanted Liver,” J Hepatology 1993;
17: 204-207.
3Troisi R, de Hemptinne B, “Clinical Relevance of Adapting Portal Vein
Flow in Living Donor Liver Transplantation in Adult Patients, Liver
Transplantation 2004; 9(9): S36-S41.
4 Lin M et al, “Hepatic Artery Thrombosis and Intraoperative Hepatic
Artery Flow Rates in Adult Orthotopic Liver Transplantation, ANZ J Surg
2002; 72: 798-800.
5 Pratschke S et al, “Arterial Blood Flow Predicts Graft Survival in Liver
Transplant Patients,”Liver Transplantation 2011; 17: 436-445.
Hashimoto K, Miller CM, Quintini C, Aucejo FN, Hirose K, Uso TD, Trenti
L, Kelly DM, Winans CG, Vogt DP, Eghtesad B, Fung JJ, “Is impaired
hepatic arterial buffer response a risk factor for biliary anastomotic
stricture in liver transplant recipients?” Surgery 2010; 148(3): 582-8.
(9648AHM)
Kelly DM, Shiba H, Nakagawa S, Irefin S, Eghtesad B, Quintini C,
Aucejo F, Hashimoto K, Fung JJ, Miller C., “Hepatic blood flow plays
an important role in ischemia-reperfusion injury.” Liver Transpl. 2011
Dec;17(12):1448-56. (9647AHM)
FLOWPROBE RECOMMENDATIONS
VESSEL
Equipment Needed
Probe Series
4-8
-FMV
Portal vein
8 - 14
-FMV, -AU
8
-FMV, -FSB
Common iliac a
HT364 Dual-channel Optima Flowmeter permits simultaneous
measurements with two Flowprobes.
Probe Size (mm)
Hepatic artery
4 mm and 6mm FMV Vascular Handle Flowprobes are recommended for
hepatic arterial flow measurements.
8-14 mm -AU COnfidence
Flowprobes® provide highly accurate
measurements in vessels with fluctuating flows such as the portal vein.
The Probes may be left in place for
extended measurements and then
easily removed via a ring attached
to the pliable liner that cushions and
protects the vessel.
8 to14 mm FMV Vascular Handle Flowprobes are recommended for portal
venous flow measurements.
Adult Liver Donor Liver Transplantation
H e p a t i c
A r t e r y
Protocol
&
P o r t a l
V e i n
Living Donor
Measure right hepatic arterial and portal
venous flow before hilar dissection.
Document measurements to serve as guide for
expected flows in the recipient.
Recipient
Recipient Hepatic Flow
Recipient Portal Flow
Measure hepatic blood flow
Measure portal blood flow
- following reperfusion
- before biliary anastomosis
- before wound closure
- following reperfusion
- after portal pressure measurement
- before biliary anastomosis
Compare with pre-transplant
hepatic arterial flow
Compare with pre-transplant portal
venous flow
Flow increased
up to 3 times
pre-transplant
portal flow
< 50 mL/min
Examine anastomosis
for arterial thrombosis
> 100 mL/min
Flow increased > 3 times
pre-transplant portal flow
or >250 mL/min/110 gram
graft weight
Reduced graft inflow
by shunting portal flow
away from liver1
Remeasure hepatic flow
Remeasure portal flow
Flow has
increased
Document flows and save waveforms for the
operative record for post-op diagnostic consideration
Troisi R, de Hemptinne B, “Clinical
Relevance of Adapting Portal Vein Flow in
Living Donor Liver Transplantation in Adult
Patients,” Liver Transplantation 2004;9(9)
Suppl 1 pp S36-S41. (6884AH)
Liver Transplant
Hepatic/Portal References Cont.
Quintini C, Hirose K, Hashimoto K, Diago T, Aucejo F, Eghtesad B, Vogt D,
Pierce G, Baker M, Kelly D, Miller CM, “Splenic artery steal syndrome” is
a misnomer: the cause is portal hyperperfusion, not arterial siphon.” Liver
Transpl. 2008 Mar;14(3):374-9.(9649AHM)
Aucejo, FN, Hashimoto, K, Quintini, C, Kelly, D, Vogt, D, Winans, C,
Eghtesad, B, Baker, M, Fung, J, Miller, C, “Triple-Phase Computed
Tomography and Intraoperative Flow Measurements Improve the
Management of Portosystemic Shunts during Liver Transplantation,”
Liver Transplantation 2008; 14: 96-99. (7606AH)
Jakab F, Rath Z, Schmal F, Nagy P, Faller J, “A New Method to Measure Portal
Venous and Hepatic Arterial Blood Flow in Patients Intraoperatively” HPB
Surgery 1996; 9(4) 238-243. (855AH)
Jakab F, Rath Z, Schmal F, Nagy P, Faller J, “The Afferent Circulation
of the Liver in Patients with Primary Hepatocellular Carcinoma,”
Hepatogastroenterology 1995;42(4) 399-402. (704AH)
Jakab F, Rath Z, Schmal F, Nagy P, Faller J, “Blood Flow Measurement in
Patients with Hepatocellular Carcinomas,” Acta Chir Hung 1994;34(1-2):
87-94. (559AH)
Wagener G, Gubitosa G, Renz J, Kinhabwala M, Brentjens T, Guarreram
JV, Emond J, Lee HT, Landry D, “Vasopressin Decreases Portal Vein
Pressure and Flow in the Native Liver during Liver Transplantation,”
Liver Transplantation 2008; 14: 1664-1670. (6673AH).
Jakab F, Rath Z, Schmal F, Nagy P, Faller J, “The Interaction between
Hepatic Arterial and Portal Venous Blood Flows; Simultaneous
Measurement by Transit-Time Ultrasound Volume Flowmetry,”
Hepatogastroenterology 1995;42(1): 18-21. (560AH
Aneman A., Eisenhofer G., Olbe L., Dalenback J., Nitescu P., Fandriks L., Friberg P.,
“Sympathetic Discharge to Mesenteric Organs and the Liver,” J Clin Invest 1996;
97(5)1640-6. (1488AH)
Jakab F, Rath Z, Schmal F, Nagy P, Faller J, “Intraoperative Estimation
Bueno J, Escartin A, Baisells J, Margarit C, “Intraoperative Flow
Measurement of Native Liver Allograft during Orthotopic Liver
Transplantation in Children, Transplant Proc. 2007 39:7:2278-9. 7605AHM)
Doi R, Inoue K., Kogire M., Sumi S., Takaori K., Suzuki T., Tobe T., “Simultaneous
Measurement of Hepatic Arterial and Portal Venous Flows by Transit-time Ultrasonic
Volume Flowmetry,” Surgery, Gynecology & Obstetrics 1988;167(1):65-69. (26AH)
Doi, R., Inoue, K., Kogire, M., Sumi, S., Takaori, K., Suzuki, T., Tobe, T., “Study on
Splanchnic Circulation: Measurement of the Liver Blood Flow,” Nippon Geka Gakkai
Zasshi, 1988;89(4):560-7. (109AH)
Figueras L., Llado L., Ramos E., Jaurrieta E., Rafecas A., Fabregat J., Torras
J., Sabate A., Dalmau A, “Temporary portocaval shunt during liver transplantation with vena cava preservation. Results of a prospective randomized study,” Liver Transpl, Vol. 7, No. 10, p. 904-11, 2001. (2201AH)
Panaro F, Bouyabrine H, Carabalona JP, Marchand JP, Jaber S, Navarro F, “Hepatic
artery kinking during liver transplantation: survey and prospective intraoperative flow
measurement,” J Gastrointest Surg. 2012 Aug;16(8):1524-30. (9796AHE)
Rasmussen, A., Hjortrup, A., Kirkegaard, P., “Intraoperative Measurement of Graft
Blood Flow - A Necessity in Liver Transplantation,” Transplant Int 1997;10(1):774-77.
(1761AHM)
Nanashima A, Pillay P, Crawford M, Nakasuji M, Verran DJ, Painter D, “Analysis of
post-revascularization syndrome after orthotopic liver transplantation: the experience of
an Australian liver transplantation center,” J Hepatobiliary Pancreat Surg, Vol. 8, No. 6,
p. 557-63, 2001. (2276AH)
Gontarczyk GW, Łagiewska B, Pacholczyk M, Trzebicki J, Jureczko L, Kołacz M,
Kosieradzki M, Adadyński L, Wasiak D, Rowiński W, “Intraoperative blood flow
measurements and liver allograft function: preliminary results,”Transplant Proc. 2006
Jan-Feb;38(1):234-6.
Jakab F, Rath, Z. Schmal F, Nagy P, Faller J, “Changes in Hepatic Hemodynamics Due
to Primary Liver Tumours,” HPB Surgery 1996; 9(4) 245-248. (854AH)
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
www.transonic.com
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 205
6181 MB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 04-2946-8541
Fax: +81 04-2946-8542
[email protected]
Renal Transplant
Medical Note
Intraoperative Blood Flow Measurement
during Renal Transplantation
Courtesy of Anders Lundell, MD, PhD, Nils H. Persson, MD, PhD,
Dept. of Transplantation, Dept. of Surgery, Malmö General Hospital, Malmö, Sweden
Renal Arterial Flow Measurement
Donor: Living Donor Kidney Retrieval
The first measurement is made on the renal artery before
the kidney is removed from the donor.
Recipient: Living Donor or Cadaver Kidneys
In primary transplantations, we use the hypogastric
artery for the arterial anastomosis. In re-transplantations
or in cases where the internal iliac is atherosclerotic the
external iliac artery is used. In selected cases, we use a
flow measurement to decide which artery to use. For the
venous anastomosis, the external iliac is used. No venous
flow measurements are made.
After completion of the arterial and venous anastomoses,
and immediately after restoration of blood flow to the
kidney, but before completion of the ureteroneocystostomy, the flow in the renal artery is measured. We use a
4 or 6 mm Flowprobe which is placed, preferably, distal
to the anastomosis. The space between the Probe and
the vessel is filled with sterile physiological saline. Care
is taken to avoid kinking the artery and to place the
Probe perpendicular to the longitudinal axis of the vessel.
Before the flow is recorded, we allow the flow signal to
stabilize for 15-20 seconds. At the end of the operation,
after the ureteroneocystostomy is completed and before
the wound is closed, we make a second measurement.
MEAN RENAL ARTERIAL FLOWS
TRANSPLANTED KIDNEY (N = 34)1
Flow: Cadaver Kidney
(mL/mm)
Donor
Flow: Living Donor Kidney
(mL/mm)
381 ± 150 SD
Post flow restoration
283 ± 148 SD
338 ± 155 SD
At end of operation
422 ± 204 SD
505 ± 177 SD
RenalTransplantMedicalNote (TX-505-mn)Rev D 2013
Schematic of Perivascular Flowprobe
measuring flow in the Renal Artery
Intraoperative Blood Flow Measurement
R e n a l
A r t e r y
M e a s u r e m e n t
Donor
P r o t o c o l
Living Donor Kidney
Cadaver Kidney
Measure renal arterial flow before removing
the kidney
No measurements
Document measurements to serve as guide for
expected renal flow in the recipient.
Recipient
Measure renal arterial blood flow following
arterial anastomosis
Adequate flow:
> 250 mL/min1
NO
YES
Check for technical error:
Apply vasodilator & wait
several minutes (up to 1 hour)
YES
Remeasure renal flow
Continue attempts to
improve flow.
NO
Adequate flow:
> 250 mL/min
YES
NO
Document measurement for operative record:
Document flows and save waveforms
for the operative record.
Assess other clinical parameters (perfusion,
urine output)
Consider post-op prophylactic treatment.2
1
Lundell A et al, “Impaired Renal Artery Blood Flow at Transplantation Is Correlated
to Delayed Onset of Graft Function” Transplant International 1996;9(1)57-61.
2
Bretan PN Jr et al, “Assessment of Preservation Induced Reperfusion Injury Via
Intraoperative Renal Transplant Blood Flow and Endothelin Concentration Studies,”
J Urology 1997;158(3):714-18.
Renal Transplantation
C a s e
Fig. 1: The donor’s renal arterial blood flow prior to excision of the kidney
measured 376 mL/min. After anastomosis to the recipient’s renal
artery, post-reperfusion renal flow measured 91 mL/min. A second
measurement was made after 30 minutes. Renal arterial flow had
increased to 290 mL/min.
Fig. 2: The donor’s renal arterial blood flow before traditional removal
of the kidney measured 538 mL/min. After anastomosis to the
recipient’s renal artery, renal flow post reperfusion measured 766
mL/min.
R e p o r t s
Fig. 3: Before a difficult laparoscopic removal of the kidney, the donor’s
renal arterial blood flow measured 622 mL/min. After anastomosis to the recipient’s renal artery, renal flow post-reperfusion
measured 322 mL/min. One hour later, flow had increased to 442
mL/min.
Fig. 4: Before laparoscopic removal of the kidney, the donor’s renal
arterial blood flow measured 91 mL/min. After anastomosis to the
recipient’s renal artery, renal flow post-reperfusion measured 290
mL/min.
Waveforms courtesy of Renal Transplantation Unit,
Hermann Hospital, Texas Medical Center, Houston, TX.
Renal Transplant
Equipment
HT354 single-channel Optima Flowmeter to acquire
precise actual flow measurement quickly and easily.
FMV Vascular Handle Flowprobes for spot flow checks during renal transplant surgery
FLOWPROBE RECOMMENDATIONS
VESSEL
HT363 dual-channel Optima Flowmeter. permits
simultaneous measurements with two Flowprobes. This
allows the ability to compare flows simultaneously, or in
quick succession, without the need for a second meter.
Probe Size (mm)
Handle Probe Series
Renal artery
4, 6
-FMV
Renal vein
10
-FMV
External iliac artery
6, 8
-FMV
Hypogastric a
4, 6
-FMV
References:
Lundell A, Persson NH, Kallen R, Ekberg H, “Impaired Renal Artery
Blood Flow at Transplantation Is Correlated to Delayed Onset of Graft
Function” Transplant International 1996;9(1)57-61. (Transonic Reference
# 685AH)
Wolffenbuttel KPet al, “Measurement of urinary flow rate using ultrasound in young boys and infants,” Journal of Urology, Vol. 47, No. 3,
p. 312-8, 2001. (Transonic Reference # 2618AH)
Wolters HH et al, “The anastomosis between renal polar arteries and
arteria epigastrica inferior in kidney transplantation: an option to
decrease the risk of ureter necrosis? Transplant International 14(6):
(Transonic Reference # 7025AH)
Bhatt KA et al, “Intraoperative graft verification in renal transplants,” Vasc
Endovascular Surg. 2002; 36(2): 93-6. (Transonic Reference # 2713AHM)
Bretan PN Jr et al, “Experimental and Clinical Assessment of PreservationInduced Reperfusion Injury Comparing Renal Transplant Blood Flow and
Renal Endothelin Concentrations,” Transplantation Proceedings 1997;
29(8): 3520-3521. (Transonic Reference # 1092AH, 54V)
Bretan PN Jr et al, “Assessment of Preservation Induced Reperfusion
Injury Via Intraoperative Renal Transplant Blood Flow and Endothelin
Concentration Studies,” J Urology 1997; 158(3): 714-18. (53V)(Transonic
Reference # 1093AH)
Alejandro V et al, “Mechanisms of filtration failure during postischemic
injury of the human kidney. A study of the reperfused renal allograft,” J Clin Invest 1995; 95(2): 820-31.(Transonic Reference # 7026AH)
Chiu C et al, “Intraoperative Reperfusion Blood Flow Predicts Post
Warm Ischemic Kidney Transplant Survival and Efficacy of Preservation
Maneuvers,” Transplantation Proc 1999; 31: 1049-1050 (Transonic
Reference # 1302AH)
Ramaswamy D et al,“Maintenance and recovery stages of postischemic
acute renal failure in humans,” AJP 2002;. 282(2): D271-80.(Transonic
Reference # 2326AH)
Dominici A et al,“Cystic leiomyosarcoma of the kidney: an unusual clinical presentation,” Urol Int 2000; 65(4): 229-31. (Transonic Reference #
2122AH)
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
www.transonic.com
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 205
6181 MB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 04-2946-8541
Fax: +81 04-2946-8542
[email protected]
Transplant Surgery
Transplant Medical Note
Portal Vein Blood Flow Measurement during Auto
Islet Cell Transplantation after Pancreatectomy
Flow Measurement during Islet Infusion
Excising a diseased pancreas removes not only pancreatic cells that produce digestive enzymes but also islet of
Langerhans cells that produce insulin to control blood
sugar. Without insulin a patient becomes diabetic and
requires lifelong use of insulin to control blood sugars.
Auto islet cell transplantation takes these islet of
Langerhans cells from the pancreas and transplants them
to the liver to reduce the diabetic risk. To do this, the
removed pancreas is processed to isolate the insulinproducing islets of Langerhans cells. The isolated cells
are suspended in a solution and are then slowly infused
through the splenic vein back into the patient’s liver where
it is hoped that they will implant, grow and produce
insulin to metabolize sugar.
Typically, 800 - 1500 cc of solution is infused into the portal
vein distal to the splenic vein (Fig. 2) over an extended
period of time. The team may elect to infuse a small
amount over 5 minutes and allow the patient to recover
before resuming the infusion. Blood pressure and flow
are monitored continuously and for ten minutes after the
infusion is completed (Fig. 1).
Infusion
bag
Auto Islet Cell Transplantation
After Pancreatectomy
c)
Liver
d)
Islet
cells
e)
b)
a)
Pancreas
Fig. 1: Steps: Auto Islet Cell Transplantation
a) Removal of pancreas (pancreatectomy)
b) Isolation of Islet cells from removed pancreas
c) Islet cells placed in Infusion bag with solution
d) Islet cells infused into splenic vein
e) Islet cells implant in liver
Flow Measurement during Islet Infusion
Surgeons measure portal venous flow during islet cell
infusion to detect any sudden decrease in flow that may
foreshadow a problem with the infusion. A 10 mm to
14 mm Perivascular Flowprobe is placed on the portal
vein and flow is measured continuously. The Flowprobe
is chosen to comfortably encompass - but not constrict the portal vein. If needed, saline can be used to provide
acoustic contact between the vein and Flowprobe.
Readings stabilize within 1-2 minutes. Wide fluctuation
of measurements may indicate improper positioning of
the Flowprobe with poor alignment or fat within the
ultrasonic sensing window. Repositioning can normally
correct this problem.
Discussion
In this high stakes auto islet cell transplantation procedure,
Flowprobes provide a continuous volumetric measure of
portal vein flow to inform the surgeon about the safety,
fluidity and success of auto islet cell transplantation.
IsletCell (TX-524-mn) Rev B 2013
Infusion
bag
Flowprobe
Islet cells
Portal vein
Splenic vein
Superior Mesenteric
Vein
Fig. 2: Enlarged view of islet cell infusion into the splenic/portal
venous system.
Transplant Surgery
Portal Vein Blood Flow Measurement during Auto Islet Cell
Transplantation after Pancreatectomy Cont.
Equipment Needs
HT354 Single-channel Optima Flowmeter. Acquire precise actual
flow measurement quickly, easily and cost effectively.
8 mm to 14 mm FMV Vascular Handle Flowprobes are recommended for portal
venous flow measurements during islet cell infusion.
COnfidence Flowprobe®
COnfidence Flowprobes® provide
highly accurate measurements
in vessels with fluctuating flows
such as the portal vein. The
Probes may be left in place for
extended measurements and then
easily removed via a ring attached
to the pliable liner that cushions
and protects the vessel.
References
Sutherland DE, Radosevich DM, Bellin MD, Hering BJ, Beilman GJ, Dunn TB,
Chinnakotla S, Vickers SM, Bland B, Balamurugan AN, Freeman ML, Pruett TL.
“Total pancreatectomy and islet autotransplantation for chronic pancreatitis,”
J Am Coll Surg. 2012 Apr;214(4):409-24.
Bramis K, Gordon-Weeks AN, Friend PJ, Bastin E, Burls A, Silva MA, Dennison
AR, “Systematic review of total pancreatectomy and islet autotransplantation for
chronic pancreatitis.”Br J Surg. 2012 Jun;99(6):761-6.
http://www.hopkinsmedicine.org/transplant/programs/auto_islet/description.
html#total_pancreatectomy
Henderson JM et al, “Hemodynamics During Liver Transplantation: The
Interactions Between Cardiac Output and Portal Venous and Hepatic Arterial
Flows,” Hepatology 1992; 16(3): 715-718.
Henderson JM et al, Volumetric and Functional Liver Blood Flow Are Both
Increased in the Human Transplanted Liver,” J Hepatology 1993; 17: 204-207.
Troisi R, de Hemptinne B, “Clinical Relevance of Adapting Portal Vein Flow in
Living Donor Liver Transplantation in Adult Patients, Liver Transplantation 2004;
9(9): S36-S41.
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
www.transonic.com
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 205
6181 MB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 04-2946-8541
Fax: +81 04-2946-8542
[email protected]
Transplant Surgery
Medical Note
Distal Spleno-renal (Warren) Shunt:
Intraoperative Blood Flow Measurements
Courtesy of J. Michael Henderson, M.D., F.A.C.S.,The Cleveland Clinic Foundation
Rationale
Splenic vein
A distal spleno-renal shunt (DSRS) provides selective variceal
decompression to control bleeding gastroesophageal varices,
while maintaining portal hypertension and prograde portal
flow to the liver (Fig. 2).
Thrombosis of distal spleno-renal shunts occur in less than 10%
of patients, but usually occurs early (in the first week) and
requires reoperation. Intraoperative measurement of shunt flow
shows great potential to reduce the risk of this complication.
Surgical Approach
On completion of the distal spleno-renal shunt anastomosis,
2-3 cm of the splenic vein is free below the pancreas before it
is anastomosed to the left renal vein. A Transonic® Flowprobe
can be placed on this segment of the splenic vein for volumetric
flow measurement (Fig. 2). A Probe is chosen to fit comfortably
around the vein without compressing it. It should lie in line
with the vessel, and no tissue should be interposed. Contact is
assured by immersing the field in saline. Flow measurements
stabilize within one minute, and fluctuate less than ± 10%.
Discussion
What should the flow be in a distal spleno-renal shunt? This is
a high flow shunt, with volumetric flows determined largely by
spleen size. There appears to be approximately 1 mL/min flow
per cubic centimeter spleen volumes - i.e. a 750 cc spleen will
give a shunt volumetric flow of approximately 750 mL/min.
After first removing the clamps, flow tends to be higher than
it will be after 5-10 minutes when the initial hyperemia has
resolved. If flow is significantly less than this approximation,
a technical error should be considered.
• Is the splenic vein kinked?
• Is there a problem with the anastomosis?
Now is the time to identify and correct a technical problem:
transit-time ultrasound Flowprobes offer a method for identifying low flow in this shunt.
Reference
http://www.vesalius.com/cfoli frms.asp
Spleno-renalshunt (TX-507-mn)Rev B 2013
Portal vein
Renal vein
Fig. 1: Schematic of splenic vein in relation to renal vein.
Spleno-renal shunt
Splenic vein
Anastomosis
Portal vein
Renal vein
Fig. 2: Schematic of anastomosis of the splenic vein to the
renal vein to create a distal Spleno-renal shunt.
Flowprobe on
Splenic vein
Portal vein
Renal vein
Fig.3: Flowprobe measuring flow in the splenic vein
following anastomosis of the splenic vein to the
renal vein.
Transplant Surgery
Distal Spleno-renal (Warren) Shunt: Intraoperative
Blood Flow Measurements Cont.
Equipment Needs
HT353 Single-channel Optima Flowmeter. Acquire precise actual
flow measurement quickly, easily and cost effectively.
8 mm, 10 mm and 12 mm FMV Vascular Handle Flowprobes are recommended
measurement of distal spleno-renal shunt (venous) flow.
Background
Alcoholic (Laennec’s) cirrhosis of the liver is a common
cause of portal hypertension. Portal hypertension
extends to esophageal veins via gastric, splenic and
gastroepiploic veins. When bulging esophageal varices
are eroded by food passage through the esophagous,
massive bleeding can result.
A distal spleno-renal shunt is a high volume shunt that
diverts splenic venous flow from the portal venous
system to the renal venous system. An enlarged spleen
(splenomegaly) is common in patients with end-stageliver disease. A distal spleno-renal shunt provides good
long-term control of variceal bleeding.
In 40% of U.S. cirrhosis patients, portal hypertension
causes acute bleeding from the varices of the esophagus
or stomach. This variceal bleeding accounts for one-third
of all deaths related to cirrhosis. A significant bleeding
episode is fatal 50% of the time. Of those surviving,
two-thirds will rebleed. It is therefore crucial to first
arrest the acute bleeding episode and then treat the
portal hypertension.
How Is a Distal Spleno-renal Shunt Constructed?
One way to treat portal hypertension is through portal
decompression via a surgically-created distal splenorenal (DSRS) or Warren shunt.
The abdomen is opened. The stomach and pancreas are
elevated to expose the splenic vein which is isolated and
mobilized by detaching it close to its junction with the
portal vein. The vein is then reattached to the renal vein
via an end-to-side anastomosis (Figs. 2,3). Intraoperative
flow measurement during creation of a DSRS ensures
good shunt flow without kinking of the vein or a
problem with the anastomosis.
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
www.transonic.com
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 205
6181 MB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 04-2946-8541
Fax: +81 04-2946-8542
[email protected]
Surgery
Transonic
Perivascular Flowprobes
®
The widest selection of Flowprobes available
Transonic’s application-customized Flowprobes measure volume
flow in blood vessels and grafts from 0.5 mm to 36 mm to:
•Quantify blood flow
•
Identify technical problems early
•
Improve patient outcomes
FlowprobeFlyer(CV-500-fly)RevB 2014
Microvascular Flowprobes
Flaps • Reattachments
Transonic® Microvascular Flowprobes measure volume flow in blood vessels or grafts from 0.5 to 4.0 mm diameter.
Flow measurement in these vessels during microvascular procedures quantify flows in the smallest vessels in order
to objectively assess the quality of the reconstruction or replantation, guide better surgical decisions and give the
surgeon the opportunity to correct otherwise undetectable flow restrictions before closing the patient. Due to
extreme accuracy requirements, this Microvascular Flowprobe Series is only available with the Optima Flowmeter.
Flexible
neck
Probe
body
Flowprobe
handle
Reflector
Microvascular Flowprobe (2 mm) showing handle and flexible probe neck for easy positioning of the Flowprobe around a vessel.
0.7 mm
1.0 mm
1.5 mm
2.0 mm
3.0 mm
Ultrasonic sensing windows of Microvascular
Flowprobe (MU) Series.
Side-by-side comparison of a 0.7 mm
Flowprobe with a tip of a 25g. needle.
Microvascular Flowprobe (-MU) Series including 0.7 mm, 1 mm, 1.5 mm, 2 mm, and 3 mm Flowprobes.
Cardiac Flowprobes
Coronary Artery Grafts • Ascending Aorta
Transonic® Cardiac Flowprobes include FMC-Series Flowprobes for coronary artery bypass grafting surgery and
COnfidence Flowprobes® for continuous measurement on great vessels with turbulent flows.
Coronary Flowprobes
Elongated curved neck
Probe body
Probe handle
Flexible neck segment
FMC-Series Coronary Handle Flowprobes are available in sizes 1.5 mm to 4 mm. They feature a
J-style reflector, designed for spot flow checks of coronary artery bypass grafts and an extended neck
with a flexible end to reach coronary grafts even behind the heart.
COnfidence Flowprobes®
Probe shell
Ultrafit
liner
COnfidence Flowprobes consist of a Flowprobe
shell and a single-use soft, flexible Ultrafit liner.
This novel concept for ultrasonic signal coupling
enables immediate, accurate beat-to-beat flow
measurements with a minimum of ultrasonic
coupling gel. The form-fitting Ultrafit Liner
slips into the transducer shell to encircle the
vessel and keep the vessel in place. The liner
cushions and protects the vessel during a flow
measurement. Liners are incrementally sized for
optimal fit on the target vessel.
®
Pictured, from left to right, are 1.5 mm,
2 mm, 3 mm and 4 mm coronary
Flowprobes showing their blue Probe
bodies, J reflectors and ultrasonic
sensing windows.
28 mm
20 mm
16 mm
14 mm
12
mm
10 mm
8 mm
24 mm
COnfidence Flowprobes® (-AU-Series), designed with four transducers, provide highly accurate measurements in vessels with highly turbulent
flows such as the ascending aorta. The Flowprobe’s slim, ergonomic profile creates a minimal footprint that fits in tight anatomical sites. The
soft, pliable liner cushions and protects the vessel. Available in 15 sizes from 8 mm to 36 mm.
Port-Access Flowprobes
Port-Access Flowprobes, a customer-driven innovation, feature a long endoscopic handle to extend through robotic ports and measure flows
on coronary grafts. They are available in three sizes: 2 mm, 3 mm, and 4 mm.
Vascular Flowprobes
Peripheral Vascular • Carotid Endarterectomy
Transonic’s spectrum of Vascular Flowprobes measure volume flows intraoperatively in vessels and grafts from
0.5 mm to 20 mm to detect blood flow obstructions before leaving the operating room. This ability to correct
otherwise undetectable flow restrictions provides the surgeon with a unique opportunity to improve the
outcome for his or her patient.
Handle Vascular Flowprobes
Probe body
J Reflector
Flexible neck
Handle
Short Handle Vascular Flowprobes: The FMV-Series features a short handle and a J reflector designed for spot flow checks. Available
in a wide range of sizes from 1.5 mm to 14 mm.
Carotid Flowprobes
Non-handle Flowprobes
Sliding cover
Probe body
L reflector
L reflector
Flexible neck
FME-Series Flowprobes feature an L-shaped reflector to protect against dislodging of
plaque (such as during carotid endarterectomy) as the Flowprobe is applied. The L reflector
design allows the probe to be slipped on and off a carotid artery easily, facilitating quick
pre- and post-procedure measurements. Available in 1.5 mm to 10 mm sizes.
Non-Handle Flowprobes (FSB-Series) feature an
ultrasonic flowsensing window defined by an L
reflector with a sliding cover so that the Flowprobe
can remain positioned around the vessel for
extended measurements. FSB-Series Flowprobes
are available in sizes from 2 mm to 14 mm.
OptiMax® Flowprobes
®
The OptiMax® family with J reflectors (shown) and L reflectors (not shown) are available in 4, 6, 8, 10 and 12 mm. OptiMax Flowprobes’ two
reflector shapes and multiple probe sizes accommodate different surgical preferences and patient anatomies. The skin tabs secure the Flowprobe
so that continuous measurements can guide vascular constructions, banding or revisions until a target flow is achieved.
Cerebrovascular Flowprobes
Aneurysm Clipping • EC-IC Bypass • AVMs • Fistulas
Transonic® Cerebrovascular (Charbel) Flowprobes measure volume flow in intracranial and extracranial vessels
during cerebrovascular flow preservation or flow augmentation surgeries. Intraoperative measurements
of volume flow assure the integrity of flow in cerebral vessels or they alert the surgeon to dangerous flow
deficits at a time when every minute counts.
Intracranial Flowprobes
Flexible
neck
Probe
body
Long bayonet neck
Reflector
Probe head
Close-up
Long bayonet neck
Long bayonet neck intracranial Charbel Micro-Flowprobes® are available in three sizes, 1.5 mm, 2 mm and 3 mm, for aneurysm
clipping, AVM and dural fistula obliteration surgeries. -MB & -MR-Series Charbel Micro-Flowprobes® are designed to measure flow
in major intracranial vessels of the Circle of Willis. Their long bayonet neck permits use under a surgical microscope and a flexible
neck segment permits bending the Flowprobe as needed to most easily position the probe around the vessel.
Extracranial Flowprobes
Short bayonet neck
Short bayonet neck extracranial Charbel Probes® are available in three sizes, 3 mm, 4 mm and 6 mm,
for extracranial vessels such as the superior temporal artery during extracranial-intracranial (EC-IC)
bypass surgeries. Their short bayonet neck permits use under a surgical microscope
and a flexible neck segment permits bending the Flowprobe as needed to most
easily position the probe around the vessel.
Side-by-side comparison between intracranial Charbel Micro-Flowprobes® and shorter neck extracranial Charbel
Flowprobes® used during EC-IC bypass surgery.
Surgery
Transplant Flowprobes
Liver • Renal • Heart/Lung • Pancreas
Transonic® Flowprobes work with HT300-Series Flowmeters to measure volume flow in blood vessels and grafts
from 0.5 to 36.0 mm. In critical transplant surgeries, intraoperative measurement of flow in vessels can guide
surgical decisions to ensure vessel patency prior to closing.
Probe body
Flexible neck
Reflector
Handle
FMV-Series 4 and 6 mm Vascular Flowprobes recommended for measuring hepatic arterial flow. Picture shows Flowprobe handle with size of Probe
in mm, the Probe’s flexible neck for optimal positioning of the Probe around the vessel, the Probe body that houses the ultrasonic transducers, and
the Probe reflector. Vessel is positioned within the Probe sensing window that is defined by the Probe body and its stationary reflector.
Vascular Flowprobes (FMV-Series) in sizes 8 mm to 14 mm are used for spot portal venous flow measurements.
COnfidence Flowprobes® (-AU-Series) can also be used for continuous portal venous flow measurements.
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
www.transonic.com
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 205
6181 MB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 04-2946-8541
Fax: +81 04-2946-8542
[email protected]
Surgery
Flowprobe Selection Guide
PERIVASCULAR FLOWPROBE SERIES & AVAILABLE SIZES
SUFFIX
DESCRIPTION
SIZES (mm)
-FMC
Coronary
1.5, 2, 3, 4
-FMV
Vascular
1.5, 2, 3, 4, 6, 8, 10, 12, 14
-FME
Carotid (L-reflector for carotid endarterectomy)
1.5, 2, 3, 4, 6, 8, 10
-FTV
OptiMax (hands-free, J-reflector)
4, 6, 8, 10, 12
-FTE
OptiMax (hands-free, L-reflector carotid endarterectomy)
4, 6, 8, 10, 12
-MU
Microvascular (handle)
0.7, 1, 1.5, 2, 3
-AU
Cardiac Output COnfidence Flowprobe
8, 10, 12, 14, 16, 20, 24, 28, 32, 36
-MB
Intracranial Charbel Micro-Flowprobe® (long bayonet handle)
1.5, 2, 3
-MB-S
Extracranial EC-IC Bypass: Micro-Flowprobe (short bayonet handle)
3, 4, 6
-FSB
Basic (no handle, L-reflector, sliding cover)
1.5, 2, 3, 4, 6, 8, 10, 12, 14
®
®
®
Recommended Sizes and/or Flowprobe Series for Specific Vessels or Applications
CARDIAC SURGERY
CABG: ON OR OFF PUMP
Probe Size
(mm)
VASCULAR SURGERY
Probe Series
Arterial conduits
1.5, 2, 3, 4
-FMC
Saphenous vein
2, 3, 4
-FMC
CARDIAC OUTPUT
Ascending aorta
28, 32, 36
-AU
Pulmonary artery
24, 28, 32
-AU
Pediatric heart
8, 10, 12,
14, 16, 20
-AU
TRANSPLANT SURGERY
Probe Size
LIVER
(mm)
Probe Series
CAROTID
ENDARTERECTOMY
Probe
Size (mm)
Common carotid artery
8, 10
-FTE
-FME
-FSB
External carotid artery
6
-FTE
-FME
-FSB
Internal carotid artery
6
-FTE
-FME
-FSB
Radial artery
2, 3
-FMV
Brachial artery
3, 4, 6
-FMV
-FTV
-FSB
Graft venous outflow
4, 6
-FMV
-FTV
-FSB
4, 6
-FMV
-FTV
-FSB
AV FISTULAS & GRAFTS
Renal bypass
4, 6, 8
-FMV
-AU
Portal vein
10, 12, 14
-FMV
-AU
Renal artery
4, 6
-FMV
-FSB
Renal vein
10
-FMV
-FSB
External iliac artery
6, 8
-FMV
-FSB
LOWER EXTREMITY BYPASS
Hypogastric artery
4, 6
-FMV
-FSB
8
-FMV
-FSB
PANCREAS
Common iliac artery
CEREBROVASCULAR SURGERY
ANEURYSM CLIPPING
Cerebral arteries
Probe Size
(mm)
Probe Series
1.5, 2, 3
-MB
-MR
Extracranial
3, 4, 6
-MB-S
MR-S
Intracranial
1.5, 2, 3
-MB
-MR
EC-IC BYPASS
-FSB
ABDOMINAL
Hepatic artery
KIDNEY
Probe Series
Aortoiliac shunt
aorta
16, 20
-AU -FSB
common iliac
10, 12
-FMV
-FTV
-AU
-FSB
Portocaval shunt
10, 12, 14
-FMV
-FTV
-AU
-FSB
Splenorenal shunt
10, 12, 14
-FMV
-FTV
-AU
-FSB
Profunda femoris
8
-FMV
-FTV
-AU
-FSB
Common femoral
8, 10
-FMV
-FTV
-AU
-FSB
Popliteal
4, 6
-FMV
-FTV
-FSB
Tibial
3, 4
-FMV
-FTV
-FSB
MICROVASCULAR SURGERY
REATTACHMENTS/FLAPS
Probe Size (mm)
Probe Series
Microvessels in hand, wrist
0.7, 1, 1.5, 2, 3
-MU
AVM, TUMOR RESECTION, DURAL FISTULA
Outflows
variable
FlowprobeSelectionGuide(CV-66-tn)RevE 2014
-MB,
-MR
www.transonic.com