Early post-operative ankle pressure indices help predict late patency rates after femoro-distal vein bypass grafting.
A prospective graft surveillance programme included 115 femorodistal autogenous vein bypass grafts that were patent when studied by measurements of ankle/brachial pressure indices (ABIs) at 3-5 weeks after operation. The grafts were followed for up to 3 years to determine whether early ABIs helped to predict subsequent failures, defined as graft thrombosis or graft or anastomotic stenosis causing diameter reduction greater than 75% treated by surgery or balloon dilatation. Receiving operating characteristics curves showed that resting ABIs predicted failure better than post-exercise ABIs or the differences between the two, and that an early resting ABI less than 0.85 was the optimal value to predict failure. Primary patency rates at 2 years were 88% for resting ABI greater than or equal to 0.85 and 36% for resting ABI less than 0.85 (p less than 0.0005). Most stenoses occurred in the grafts and not at anastomoses. Arteriographic grading of crural artery outflow was not significantly different for successful or failed grafts or for grafts with resting ABI greater than or equal to 0.85 or less than 0.85. The observation that late graft failure was 3-4 times more likely if the early post-operative ABI was low suggests that most graft failures result from faults relating to the operation.
Prime
H T
HT
Department of Vascular Surgery, Monash University, Melbourne, Australia.
Myers
K A
KA
Matthews
P G
PG
Zeng
G
G
D000368:Aged; D000842:Ankle / Q000098:blood supply / Q000503:physiopathology*; D001132:Arm / Q000098:blood supply / Q000503:physiopathology; D001794:Blood Pressure; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015993:Life Tables; D008297:Male; D011150:Popliteal Artery / Q000601:surgery*; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D013599:Systole; D016909:Tibial Arteries / Q000601:surgery; D013997:Time Factors