Perioperative noninvasive hemodynamic ankle indices as predictors of infrainguinal graft patency.
Of 129 femoropopliteal bypasses, 40 closed in 0 to 42 months. Early and late closures were not predicted by pre- or postoperative ankle/brachial pressure index (ABPI) or ankle pulse volume recording amplitude (APVR) or their increments (delta). Of 141 femorotibial bypasses, 60 closed in 0 to 12 months, with 46 closing early (less than 1 month). Early failure occurred in 19 of 52 limbs (37%) with pre-ABPI less than 0.2 and 17 of 89 limbs (19%) with pre-ABPI greater than 0.2 (p less than 0.025). Similar significant differences in early patency occurred between limbs with pre-APVR less than 5 and greater than 5 mm (29 of 94 [34%] vs. 7 of 47 [15%], respectively). Late closure was not predicted by either value. Thus in the 44 limbs with pre-ABPI greater than 0.2 and pre-APVR greater than 5 mm, only 11 grafts closed (25%), whereas if pre-ABPI was less than 0.2 or pre-APVR less than 5 mm, 49 of 97 grafts (51%) occluded within 17 months (p less than 0.025). Postoperative or delta indices had no predictive value. Preoperative ABPI less than 0.2 or APVR less than 5 mm was associated with twice the risk of early femorotibial graft closure; however, cumulative life-table patency was still 39% at 24 months.
D000842:Ankle / Q000098:blood supply*; D001794:Blood Pressure; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular; D006801:Humans; D010991:Plethysmography; D011150:Popliteal Artery / Q000601:surgery*; D011379:Prognosis; D011674:Pulse; D013997:Time Factors; D014463:Ultrasonography