The importance of routine surveillance of distal bypass grafts with duplex scanning: a study of 379 reversed vein grafts.
To assess the utility of routine duplex surveillance, 379 infrainguinal reversed vein grafts performed at two independent teaching hospitals were prospectively entered into a surveillance protocol from March 1986 through August 1989. An average of 3.2 postoperative duplex graft flow velocity (GFV) measurements per graft was obtained during a mean follow-up interval of 21 1/2 months. Only 2.1% of 280 grafts with GFV measurements greater than 45 cm/sec failed within 6 months of a normal surveillance examination. GFV measurements less than 45 cm/sec in 99 grafts led to arteriography in 75 grafts, identifying 50 stenotic lesions in 48 bypasses (12.6% of series). Inflow lesions were present in 5%, outflow stenoses in 2%, and intrinsic graft stenoses in only 6% of bypasses. Only 29% of grafts identified as failing by duplex scan were associated with a reduction in ankle-brachial index of greater than 0.15. Secondary reconstructions were performed in 48 grafts based on detection of a reduced GFV measurement; all such reconstructions are patent after a mean follow-up of 5 months. Duplex surveillance is more reliable in identification of failing vein grafts than is determination of ankle-brachial index.
Mills
J L
JL
Vascular Surgery Service, Wilford Hall USAF Medical Center/SGHSG, Lackland AFB, TX 78236-5300.
Harris
E J
EJ
Taylor
L M
LM
Beckett
W C
WC
Porter
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging / Q000637:transplantation*