DOCSLIB.ORG

Saphenous Vein Bypass Grafting for Coronary Atherosclerosis: Clinical Experience

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Saphenous Vein Bypass Grafting for Coronary Atherosclerosis: Clinical Experience MEDICAL PRACTICE Saphenous vein bypass grafting for coronary atherosclerosis: clinical experience. A. S. Trimble, m.d., L. L. Black, m.d. and H. E. Aldridge, m.d., Toronto Summary: Saphenous vein bypass Direct myocardial revascularization meticulous to allow perfect intima- grafting is a recent and important for coronary atherosclerosis using to-intima approximation. Great care procedure in the management of reversed saphenous veins grafted to must also be taken in the determina¬ atherosclerotic coronary artery the distal coronary arterial tree has tion of the length of the graft prior disease. A review of the first 150 been popularized by surgical groups to its anastomosis to the aorta. patients operated on to July 1971 at in Milwaukee and Cleveland.14 the Toronto General Hospital is This procedure has been accepted Bypass graft experience presented. Many had multiple bypass with unprecedented enthusiasm by The combined experience of all car¬ grafts and some had additional many cardiovascular centres. Each diac surgeons at the Toronto Gen¬ procedures including internal week, around the world, the opera¬ eral Hospital to July 1, 1971 includes mammary artery implantation, valve tion is being performed on literally 150 patients. The ages range from replacement and scar tissue hundreds of patients. 26 to 65 years with a mean of 49 resection. There were five operative At the Toronto General Hospital years. One hundred and forty pa¬ deaths (3%) and an additional we have accumulated experience with tients were men and 10 were women. five hospital deaths; the majority 232 patients over the past three All patients were experiencing an¬ were related to myocardial years. Although we entered the field gina. Ninety-eight had had previous infarction. cautiously the early excellent results evidence of myocardial infarction A clinical review of the results six have so impressed surgeons and and 38 of these had had at least two months to three years after operation cardiologists that the number of pa¬ infarctions. Congestive failure was indicates marked improvement in tients being operated on is rapidly being managed medically in 17 pa¬ over 80% of the survivors. increasing (Fig. 1). This report re¬ tients. Postoperative hemodynamic studies views our experience with the first Ten patients had systemic hyper¬ were performed in many. It is 150 patients operated on up to July tension (greater than 140/90 mm. suggested that patients with poor 1, 1971. It offers therefore a six- Hg). Ten had peripheral vascular myocardial function presenting in month to three-year clinical follow- occlusive disease in the lower extrem¬ failure may not benefit from the up. ities. Over two thirds of the patients operation. smoked one or more packages of Operative technique cigarettes a day, many for 20 years. From the Cardiovascular Unit and the The technique for operation has be¬ A similar number gave a family his¬ Division of Cardiovascular Surgery, Toronto come standardized and only a brief tory indicative of coronary disease. General Hospital, Toronto, Ontario. comment is in order. It should in¬ Most patients were receiving a va¬ Supported by the Ontario Heart Foundation. clude total cardiopulmonary bypass riety of medications including digox¬ Reprint requests to: Dr. A. S. Trimble, with adjuncts of normo- or hypo¬ in, diuretics, nitroglycerin or isosor- Cardiovascular Unit, Toronto General thermic anoxic cardiac elec- bide dinitrate and A 101 arrest, propranolol. Hospital, College Street, total of 218 were Toronto 2, Ontario. trical fibrillation and venting in grafts performed in order to provide a perfectly still, dry the 150 patients (Fig. 2). Additional field for performing the anastomo- combined procedures included in¬ ses. Suturing must be carried out ternal mammary implantation in 16, under magnification and must be resection of scar tissue in four and C.M.A. JOURNAL/OCTOBER 7, 1972/VOL. 107 649 aortic valve replacement in five. groups. In Group A there were 115 Discussion patients for follow-up. Of these, 97 Like many others1'7 we have been Results (84%) were considered to be clinical¬ impressed by the early results of my¬ There were five operative deaths ly markedly improved. The majority ocardial revascularization using the (3%) and five additional hospital had no angina whatsoever; 16 pa¬ saphenous vein bypass technique. deaths (3%). Four ofthe five patients tients (14%) were unimproved and From the beginning we were con¬ who died at operation showed evi¬ there were two late deaths from myo¬ cerned about the generalizations that dence of recent infarction and could cardial infarction. In Group B eight all patients with coronary atheroscle¬ not sustain a blood pressure when of the 10 survivors (80%) could be rosis were candidates for this proce¬ taken off the heart-lung machine. All initially considered improved. How¬ dure, that all vessels were graftable grafts in these patients were patent. ever improvement was not nearly as and that all patients could be mark¬ Four of the five hospital deaths were dramatic as in the Group A patients edly benefited. also due to recent myocardial in¬ and tended to occur early in the post¬ This review suggests that patients farction, confirmed at autopsy. In operative course. Within six months with extensive myocardial dysfunc¬ three of these thrombosis of the graft only four of the 10 survivors could tion are unacceptable for surgery had led to infarction of ventricular still be considered improved. Seven because of a high operative mortali¬ muscle in the area of distribution of of the 10 patients were on anti-fail¬ ty and usually unimpressive im¬ the grafted coronary artery. In the ure therapy and the majority of them provement in their symptomatology. fifth patient thrombophlebitis at the had not returned to work. One pa¬ The majority of such patients pre¬ graft donor site led to recurrent and tient was not improved and there sented with congestive failure and finally fatal pulmonary embolism. was one late death due to myocardial angina was only a minor component Early or late myocardial infarction infarction. of their disability. It seems illogical was diagnosed in 14 patients, 11 oc¬ to expect any form of revasculariza¬ curring in hospital. The other three tion to improve myocardial func¬ patients who developed late infarc¬ Preinfarction angina tion if extensive fibrosis of the myo¬ tion had had graft patency demon¬ Many centres are reporting success¬ cardium has occurred. However, strated to One of ful bypass surgery in patients with there be some It is prior discharge. From this may exceptions. these was "preinfarction angina". difficult to distinguish by ventri¬ patients re-investigated series we have to and found to have thrombosis of been able select 18 a fibrosed myo¬ who fit into this cate¬ culography diffusely both grafts. patients may cardium from one that is hypoper- A classical postpericardiotomy gory. fused. Only in isolated circumstances syndrome developed in 22 patients. In 13 the angina was of a crescen- should patients with Grade IV ven- Thrombophlebitis at the donor do type with pain of increased fre¬ site of the graft occurred in 14 pa¬ quency but short duration, always tients, with subsequent pulmonary relieved by nitroglycerin. The pain TORONTO GENERAL HOSPITAL embolism in six. In one patient this often occurred at rest and in the ma¬ CORONARY BYPASS GRAFTS (232 PATIENTS) was massive and fatal (see above). jority, nitroglycerin consumption An attempt was made to correlate had increased from a few tablets mortality, complications and late daily to as many as 100 per day. In improvement with the preoperative this group there were no hospital or clinical findings and catheterization late deaths. Twelve (95%) were mark¬ data. The cineangiographic grading edly improved with total relief from of left ventricular function, using the their angina. classification of Lansdown, Aldridge The other five patients differed and in that to ex¬ Spratt,5 permitted meaningful clinically they began FIG. 1.The marked increase in number of of an¬ prognostic separation patients perience prolonged episodes of bypass operations at the Toronto General with Grades I to III from those with gina and obtained little relief with Hospital over the past three years. Grade IV function. (This is an an¬ nitroglycerin. Often meperidine was giographic classification of ventricu¬ required to relieve the pain, which lar and is not also occurred at rest but in a mark¬ contractility equivalent 150 PATIENTS to the clinical grading of the New edly different pattern. In this group York Heart Association functional there were two hospital deaths and classification.) one late death due to myocardial in¬ 218 VEIN BYPASS GRAFTS Table I sets forth data on hospital farction. The two surviving patients mortality and complications such as have remained unimproved; one has myocardial infarction, arrhythmia had at least two myocardial infarcts and congestive failure in the two during the follow-up period. Table I FIG. 2.The coronary vessels grafted. 650 C.M.A. JOURNAL/OCTOBER 7, 1972/VOL. 107 tricular function be accepted for sur- there has been a return to internal coronaire: experience clinique gery and then only if all areas affect- mammary implantations and now a ed can be revascularized. number of combined procedures are La greffe de veine saphene pour pon- Patient volume has prohibited us being carried out. Statistics dating tage est une recente operation, im- from assessing all grafts in the early back to 1953 on the use of the in- portante pour le traitement de la postoperative period by repeat an- ternal mammary implant show that maladie atherosclerotique des arte- giography. Of 47 patients who had in 60 to 65% of patients, filling of res coronaires. Les auteurs passent excellent clinical results within six the coronary arterial tree from the en revue les 150 premiers malades months of operation, all had at least implant can be demonstrated.
Load more

Recommended publications
  • Improving the Interstate Highway System Chase Minor [email protected]
    The University of Akron IdeaExchange@UAkron Williams Honors College, Honors Research The Dr. Gary B. and Pamela S. Williams Honors Projects College Fall 2019 Improving the Interstate Highway System Chase Minor [email protected] Please take a moment to share how this work helps you through this survey. Your feedback will be important as we plan further development of our repository. Follow this and additional works at: https://ideaexchange.uakron.edu/honors_research_projects Part of the Geographic Information Sciences Commons Recommended Citation Minor, Chase, "Improving the Interstate Highway System" (2019). Williams Honors College, Honors Research Projects. 897. https://ideaexchange.uakron.edu/honors_research_projects/897 This Honors Research Project is brought to you for free and open access by The Dr. Gary B. and Pamela S. Williams Honors College at IdeaExchange@UAkron, the institutional repository of The nivU ersity of Akron in Akron, Ohio, USA. It has been accepted for inclusion in Williams Honors College, Honors Research Projects by an authorized administrator of IdeaExchange@UAkron. For more information, please contact [email protected], [email protected]. Improving Interstate Highway System 1 Improving the Interstate Highway System Honors Thesis Project Presented to The University of Akron Honors College In Partial Fulfillment of the Requirements for the Degree Geography: GIS Bachelors of Science Chase A. Minor Spring 2019 Improving Interstate Highway System 2 Abstract The Interstate Highway System is the primary transportation network of the United States. The Interstate Highway System has succeeded and failed in certain ways in connecting the United States. It is important that new interstate highways are added so that the United States will be better connected.
    [Show full text]
  • Highway 71 Improvement Study I Executive Summary This Page Intentionally Left Blank
    HIGHWAY 71 CORRIDOR IMPROVEMENT STUDY BELLA VISTA BYPASS – MISSOURI STATE LINE BENTON COUNTY Executive Summary DRAFT December 2017 Highway 71 Corridor Improvement Study Bella Vista Bypass to Missouri State Line BENTON COUNTY EXECUTIVE SUMMARY Prepared by the Transportation Planning and Policy Division Arkansas Department of Transportation In cooperation with the Federal Highway Administration This report was funded in part by the Federal Highway Administration, U.S. Department of Transportation. The views and opinions of the authors expressed herein do not necessarily state or reflect those of the U.S. Department of Transportation. ARKANSAS DEPARTMENT OF TRANSPORTATION NOTICE OF NONDISCRIMINATION The Arkansas Department of Transportation (Department) complies with all civil rights provisions of federal statutes and related authorities that prohibit discrimination in programs and activities receiving federal financial assistance. Therefore, the Department does not discriminate on the basis of race, sex, color, age, national origin, religion (not applicable as a protected group under the Federal Motor Carrier Safety Administration Title VI Program), disability, Limited English Proficiency (LEP), or low-income status in the admission, access to and treatment in the Department’s programs and activities, as well as the Department’s hiring or employment practices. Complaints of alleged discrimination and inquiries regarding the Department’s nondiscrimination policies may be directed to Joanna P. McFadden Section Head - EEO/DBE (ADA/504/Title VI Coordinator), P.O. Box 2261, Little Rock, AR 72203, (501) 569-2298, (Voice/TTY 711), or the following email address: [email protected] Free language assistance for the Limited English Proficient individuals is available upon request. This notice is available from the ADA/504/Title VI Coordinator in large print, on audiotape and in Braille.
    [Show full text]
  • Download Bypass Basics Brochure
    ity un m Bypass Basics om d C ze -Si ium Co Med nside and ring a Bypass in Your Small by•pass /ˈbīˌpas/ noun Prepared by CUTR for the a road passing around a town or its center to FDOT Systems Planning Office 2014 provide an alternative route for through traffic. www.dot.state.fl.us/planning/systems/ - Google Dictionary Bypass Basics why build a bypass? Your community may be asked to consider a bypass to relieve traffic congestion and to improve travel time for those passing through – especially trucks. Desire for a bypass is increasing for state highways on Florida’s Strategic Intermodal System (SIS) that run through small- and medium-sized communities. This is because “SIS” highways are designated to provide for the statewide movement of people and goods and, therefore, are critical to the economy. is a bypass needed? Questions to ask Major state highways are often the main street in small and medium-sized Why is FDOT proposing a communities. This means they serve local, as well as regional, travel. bypass in this community? Freight and through traffic in these communities contribute to traffic congestion and have other adverse impacts on quality of life. A highway bypass may be appropriate where heavy truck traffic causes continuing unacceptable impacts, such as noise, fumes, and vibration. It may also Statistics from recently be appropriate where a high percentage of trips are just passing through completed bypasses in Florida: the community. In these situations, the bypass would significantly reduce traffic congestion and pollution. • Bypasses circumvent communities with populations ranging from 10,000 to Roadways on Florida’s Strategic Intermodal System (SIS) support economic 90,000–most with a population under 25,000.
    [Show full text]
  • Economic Impacts of Highway Bypasses on Communities
    The Economic Impacts of Highway Bypasses on Communities Summary A research project by the Wisconsin Department of Transportation January 1998 (reformatted in April of 1999 for Internet placement) 1 NOTICE: This research was funded by the Wisconsin Council on Research of the Wisconsin Department of Transportation (WisDOT) and the Federal Highway Administration (FHWA). The contents of this report reflect the research findings of the staff of WisDOT’s Economic Planning & Development Section, who are responsible for the accuracy of the data contained herein. The contents do not necessarily reflect official views or policies of WisDOT or FHWA at the time of publication. This document is disseminated under the sponsorship of WisDOT and FHWA in the interest of information exchange. The United States Government assumes no liability for its contents or use thereof. This report does not constitute policy standards, specifications or regulations. The United States Government does not endorse products or businesses. Trade, publication or product names may appear in this report only because they are considered essential to the research conducted in the study. 2 3 INTRODUCTION KEY PROJECT FINDINGS: Since 1980, there have been State Highway bypasses built around 17 Wisconsin communities. Through • In most communities, highway bypasses have the year 2010, at least 20 more bypasses are little adverse impact on overall economic anticipated for construction. activity. The economies of smaller communities have a greater potential to be adversely impacted by a bypass. Bypass plans often generate local concern about impacts on local commerce, development, land use, • Over the long term, average traffic levels on and general quality of life.
    [Show full text]
  • Roadway &Traffic Operations Strategy
    ESTABLISHING MULTI-MODAL STRATEGIES | CHAPTER 4 ROADWAY & TRAFFIC OPERATIONS STRATEGY To serve planned growth, the future transportation system needs multi-modal improvements and strategies to manage the forecasted travel demand. This chapter presents a detailed strategy to improve Moscow’s roadway network and traffic operations over the next 20 years, including network connectivity options, regional circulation enhancements, intersection modifications, and multi-modal street design guidelines. MULTI-MODAL TRANSPORTATION PLAN This page intentionally left blank. Moscow on the Move 4 ROADWAY & TRAFFIC OPERATIONS STRATEGY Supporting the guiding principles of Moscow on the Move, the Roadway & This Transportation Traffic Operations Strategy strives to provide a truly multi-modal Commission “check mark” icon signifies transportation system and improve safety, access, and mobility for all street which actions have unanimous users by identifying strategies, policies, and projects that help achieve support from the Commission. Moscow’s vision for mobility and access. This strategy of Moscow on the Move The icon is a way to illustrate the level of support for identifies opportunities to retrofit existing streets in Moscow and develops the implementation. street grid to improve citywide connectivity for motor vehicles, pedestrians, bicyclists, and transit users. This strategy specifically provides an overview of the existing traffic conditions and how conditions might change by 2035, a street network plan, various design tools that could be applied throughout the city, and descriptions of recommended street projects. FUTURE DEFICIENCIES AND NEEDS Existing and future roadway and traffic operation conditions were assessed to determine the needs and deficiencies of the system. The key areas projected to require improvement or to present future challenges are summarized below.
    [Show full text]
  • The Effects of Highway Bypasses on Rural Communities and Small Urban
    NCHRP National Cooperative Highway Research Program RnsEnncH REsurrs DIcEST Number 210 Subjcct Arca: IA Planning and Adrninistration Responsible Senior Progranr Oflìcer: Scott A. .Sabol EFFECTS OF HIGHWAY BYPASSES ON RURAL COMMUNITIES AND SMALL URBAN AREAS c.. I This RRD is a staf digest of a study cottducted as part of NCHRP Project 20-5, " Synthesis of Information Related- to llighway Problerns," for which the Transportatiott Research Board is tlrc agency conducting tlrc research. The Principal Investigator responsible for this project is Sally D. I.iff, Manager, Synthesis Studies, serving under the Studies and lnþrmation Services Division of the Board. Dr. Jesse Bufington and Ms. Katie Womack, of the Texas Transporhrion Institute were responsible for data collection, initial analyses and report preparation. Dr. Andrew C. I-emer conducted additional analyses and prepared the final text. INTRODUCTION challenged decision makers. Transportation planners seek to improve transportation system efficiency by In the late fall of 1964, a new highway bypass constructing bypasses, while people in the towns to be around Cherokee,Iowa (1990 population 6,026) opened bypassed protest the diversion of traffic that some view to t¡affic. l¡cal business people had actively opposed as their sotuce of livelihootl. Such issues are particu- the construction, t'earing that traffic diverted from the larly acute in rural communities and small urban a¡eas, main route ttuough town would take sales with it. Just where highway orienæd development may account for a over two decades later, the former o\uìer of a clothing substantial proportion of the local economy. store in Cherokee echoetl the views of many others in the town when he concluded that he and others had over-reacted: the bypass did not hurt retail sales.
    [Show full text]
  • Bella Vista Bypass Safety Analysis Introduction a Safety Analysis
    Bella Vista Bypass Safety Analysis Introduction A safety analysis was conducted for the Highway 71 corridor between Highway 71B interchange south of the City of Bella Vista and Highway H south of Pineville (study area). The analysis considered crashes occurring in years 2006 and 2007, and examined crashes by severity, and crashes by type of impact. Additional crash data analysis for earlier years can be found in the Final Environmental Impact Statement completed in 2000. In 2006, there were 93 crashes in Arkansas, and 65 crashes in Missouri. In 2007, the Arkansas portion of the study area had 100 crashes, with 77 crashes in Missouri. This is an average number of crashes of 168 crashes per year within the entire corridor. Crash Rates Arkansas study area crash rates for the existing corridor were 1.27 crashes per million vehicle miles (MVM) in 2006, and 1.23 crashes per MVM in 2007. Comparatively, the statewide average crash rates were 2.37 and 2.50 for years 2006 and 2007, respectively, for similar facility types. Crash rates for the existing corridor in Missouri were 1.25 crashes per MVM and 1.49 crashes per MVM for 2006 and 2007, respectively. The statewide average crash rate in Missouri for similar type facilities was 1.53 crashes per MVM in 2007. Severity of Crashes Table S-1 displays the number and severity of crashes that have occurred along existing Highway 71 within the study area. Over the two-year study period, there were a total of 7 crashes that resulted in 7 fatalities, 134 crashes that resulted in 317 people injured, and 194 crashes that resulted in property damage only.
    [Show full text]
  • Route 66 in Illinois: (2012/13 Update and Expansion of the Original 1994/95 Survey)
    Route 66 in Illinois: (2012/13 Update and Expansion of the Original 1994/95 Survey) IDOT Sequence #17337 & #17337A Prepared for: • Illinois Department of Transportation • Parsons Brinckerhoff • Knight E/A, Inc. Prepared by: Heritage Research, Ltd. Historical & Environmental Consultants Menomonee Falls, WI 53051 22 December 2013 Sequence Map 1994/95 Historic 2012/13 Number Code Negative # Address/Location Type Date Built Function 1994/95 Comments Comments and Photo Image # Table of Contents: Introduction 004 Historical Summary 004 Route 66 Survey (1994/95 & 2012/13) & Miscellaneous Observations 008 City of Chicago to City of Plainfield 014 Adam Street: Michigan Avenue to Ogden Avenue (one way west) 014 Jackson Street: Michigan Avenue to Ogden Avenue (one way east) 027 Ogden Avenue: Jackson Street (City of Chicago) to Harlem Street (City of Lyons) 043 Ogden Avenue/Lawndale Avenue Alignment (City of Lyons, 1926-1928) 078 Harlem Avenue to Joliet Road (Various Municipalities) 082 City of Plainfield: Bypass Alignment (Post-1940) 095 City of Joliet & Vicinity 098 IH-55 (Exit) 268 to Des Plaines River Bridge (City of Joliet) 098 Ottawa Street: Des Plaines River to W. Allen Street (southbound realignment off Chicago Street) 122 Original Alignment: Chicago Street (southbound) and Scott Street (northbound) 126 Chicago Street: Two-way Traffic, Allen Street to Laraway Road 135 Business RT 66: Joliet (Laraway Road) to Gardner (via IL 53) 141 Laraway Road to Wilmington 141 Wilmington 154 Wilmington to Gardner 174 Bypass RT 66: Joliet to Gardner (via
    [Show full text]
  • Route 66 Economic Impact Study Contents 6 SECTION ONE Introduction, History, and Summary of Benefi Ts
    SYNTHESIS OF FINDINGS A study conducted by Rutgers, The State University of New Jersey in collaboration with the National Park Service Route 66 Corridor Preservation Program and World Monuments Fund Study funded by American Express SYNTHESIS OF FINDINGS A study conducted by Rutgers, The State University of New Jersey in collaboration with the National Park Service Route 66 Corridor Preservation Program and World Monuments Fund Study funded by American Express Center for Urban Policy Research Edward J. Bloustein School of Planning and Public Policy Rutgers, The State University of New Jersey New Brunswick, New Jersey June 2011 AUTHORS David Listokin and David Stanek Kaitlynn Davis Michael Lahr Orin Puniello Garrett Hincken Ningyuan Wei Marc Weiner with Michelle Riley Andrea Ryan Sarah Collins Samantha Swerdloff Jedediah Drolet Charles Heydt other participating researchers include Carissa Johnson Bing Wang Joshua Jensen Center for Urban Policy Research Edward J. Bloustein School of Planning and Public Policy Rutgers, The State University of New Jersey New Brunswick, New Jersey ISBN-10 0-9841732-3-4 ISBN-13 978-0-9841732-3-5 This report in its entirety may be freely circulated; however content may not be reproduced independently without the permission of Rutgers, the National Park Service, and World Monuments Fund. 1929 gas station in Mclean, Texas Route 66 Economic Impact Study contents 6 SECTION ONE Introduction, History, and Summary of Benefi ts 16 SECTION TWO Tourism and Travelers 27 SECTION THREE Museums and Route 66 30 SECTION FOUR Main Street and Route 66 39 SECTION FIVE The People and Communities of Route 66 51 SECTION SIX Opportunities for the Road 59 Acknowledgements 5 SECTION ONE Introduction, History, and Summary of Benefi ts unning about 2,400 miles from Chicago, Illinois, to Santa Monica, California, Route 66 is an American and international icon, myth, carnival, and pilgrimage.
    [Show full text]
  • The Impact of a New Bypass Route on the Local Economy and Quality of Life
    ResearchReport KTC-01-10/SPR-219-00-2I KENTUCKY TRANSPORTATION CENTER CollegeofEngineering THEIMPACTOFANEWBYPASSROUTEON THELOCALECONOMYANDQUALITYOFLIFE OurMission Weprovideservicestothetransportationcommunity throughresearch,technologytransferandeducation. Wecreateandparticipateinpartnershipstopromote safeandeffectivetransportationsystems. WeValue... Teamwork--ListeningandCommunicating,AlongwithCourtesyandRespectforOthers HonestyandEthicalBehavior DeliveringtheHighestQualityProductsandServices ContinuousImprovementinAllThatWeDo Formoreinformationoracompletepublicationlist,contactus KENTUCKYTRANSPORTATIONCENTER 176RaymondBuilding UniversityofKentucky Lexington,Kentucky40506-0281 (859)257-4513 (859)257-1815(FAX) 1-800-432-0719 www.ktc.uky.edu [email protected] TheUniversityofKentuckyisanEqualOpportunityOrganization Research Report KTC-01-10/SPR219-00-2I The Impact of a New Bypass Route on the Local Economy and Quality of Life by Eric Thompson Associate Director Joseph Miller Research Assistant and Jonathon Roenker Research Associate Center for Business & Economic Research Carol Martin Gatton College of Business & Economics University of Kentucky, Lexington, Kentucky Under subcontract with Kentucky Transportation Center College of Engineering University of Kentucky in cooperation with Kentucky Transportation Cabinet Commonwealth of Kentucky and Federal Highway Administration U.S. Department of Transportation The contents of this report reflect the views of the authors who are responsible for the facts and accuracy of the data presented herein.
    [Show full text]
  • Setting the Stage: Upgrade Highway 50
    SETTING THE STAGE: UPGRADE HIGHWAY 50 The safety and economic effects of upgrading Highway 50 to four lanes across the state of Missouri take on greater significance in the context of the future rebuild of Interstate 70 and Interstate 44. This is a rare opportunity to get ahead of the curve. An upgraded Highway 50 will provide optimal performance of the roadway system during reconstruction phases of Interstate 70 and Interstate 44 as well as long‐term benefits to be realized by the adjacent communities and the entire state of Missouri. History as a Detour Due to flooding of Routes 63 and 54 near Jefferson City in 1993, a detour route to Jefferson City included Highway 50. During the repairs on the I‐70 Bridge at Rocheport, alternate route signs on I‐70 directed traffic around the bridge south on Route 65 to Route 50 to avoid excessive delays at the bridge. No one anticipated the magnitude of the traffic impacts that recent construction along I‐44 near Rolla would create. When these situations arose, Highway 50 provided needed relief to those travelling within the I‐44 corridor. Successfully reacting to the needs of the motoring public during past construction was the catalyst for proactively creating a comprehensive Incident Management Plan for I‐44 (MoDOT, District 9). Highway 50 is included as part of its network of potential detours. Be Proactive. Highway 50 WILL be a necessary detour during multiple phases of I‐70 and I‐44 reconstruction. SERVING I-70 & I-44 REBUILD HIGHWAY 50 INTO THE FUTURE Traffic Diversion During I‐70 and I‐44 construction, it Economy On average each year, investment in four is projected that up to 10% of all traffic will divert to other lanes on Highway 50 will create 1,550 new jobs paying an routes.
    [Show full text]
  • Transportation Improvement Program
    2020 - 2025 Transportation Improvement Program Contents Section 1 - About the Transportation Improvement Program: Page 1 Section 2 - Project Selection: Page 5 Section 3 - Fiscal Constraint: Page 18 Section 4 - Environmental Justice: Page 27 Section 5 - Project Tables: Page 35 About MAPA The Omaha-Council Bluffs Metropolitan Area Planning Agency (MAPA) is a regional Council of Governments. It was created in 1967 under the terms of an interlocal agreement to provide a forum for coordinating local planning and development activities. As an organization of local governments, we exist to help member governments address problems that are regional in scope and may cross jurisdictional boundaries. MAPA has no regulatory powers. It can consider any matter which may or should involve interlocal governmental cooperation or coordination. It recommends, but does not implement, plans and programs that it prepares, reviews or adopts. It also provides review and comment on local applications for federal and state funds. The Omaha-Council Bluffs Metropolitan Area Planning Agency (MAPA) prepared this report with funding from the U.S. Department of Transportation’s Federal Highway Administration and Federal Transit Administration, and in part through local matching funds of MAPA’s member governments. These contents are the responsibility of the MAPA. The U.S. government and its agencies assume no liability for the contents of this report or for the use of its contents. MAPA’s Board of Directors approved this document on June 27, 2019. Please call 402-444-6866 to obtain permission of use. Section 1 - About the Transportation Improvement Program 1.1 Legislative Requirements The current authorized federal transportation legislation is the Fixing America’s Surface Transportation (FAST) Act.
    [Show full text]