title: Serial noninvasive studies do not herald postoperative failure of femoropopliteal or femorotibial bypass grafts.
abstract: We performed a 5-year retrospective case-control study of 232 patients undergoing femoropopliteal (n = 188) or femorotibial (n = 44) bypass to determine if serial noninvasive studies herald postoperative graft failure. We correlated serial ankle/arm pressure indices (API) with graft patency. An interval drop in API of greater than or equal to 0.20 was considered hemodynamically significant, but interventional therapy was carried out only for clinically symptomatic graft failure and an API less than 0.20 above the preoperative value. The cumulative 5-year limb salvage rate was 82% and the patient survival was 63%. A significant drop in API did not correlate with cumulative 5-year graft patency. The 5-year cumulative primary graft patency rates were 60% and 62% in patients with stable and interval drops in API, respectively (Z = 0.15, p = N.S.) These results suggest that a significant drop in postoperative API does not predict patients with impending femoropopliteal or femorotibial graft failure. We believe that routine noninvasive surveillance and prophylactic intervention on detected asymptomatic lesions in leg bypass grafts may not be justified.
authors.affiliation: Department of Surgery, University of Arkansas for Medical Sciences, Little Rock 72205.
authors.forename: R W
authors.initials: RW
authors.lastname: Barnes
authors.forename: B W
authors.initials: BW
authors.lastname: Thompson
authors.forename: C M
authors.initials: CM
authors.lastname: MacDonald
authors.forename: M L
authors.initials: ML
authors.lastname: Nix
authors.forename: A
authors.initials: A
authors.lastname: Lambeth
authors.forename: A D
authors.initials: AD
authors.lastname: Nix
authors.forename: D W
authors.initials: DW
authors.lastname: Johnson
authors.forename: B H
authors.initials: BH
authors.lastname: Wallace
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006084:Graft Rejection; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D012189:Retrospective Studies; D013977:Tibia / Q000098:blood supply*; D014463:Ultrasonography