title: Intensive surveillance of femoropopliteal-tibial autogenous vein bypasses improves long-term graft patency and limb salvage.
abstract: OBJECTIVE
  The authors determined the impact of an intensive surveillance program of autogenous vein bypasses on patency and limb salvage.
  
  
  BACKGROUND
  Surveillance protocols of vein bypasses can identify graft-threatening lesions to permit elective revisions before thrombosis. The authors compared follow-up based on clinically indicated procedures with intensive surveillance.
  
  
  METHODS
  From 1985 to 1994, 615 autogenous vein bypasses (454 in situ, 161 reversed/composite) to popliteal (n = 169) and tibial (n = 446) arteries were performed for critical limb ischemia (n = 507), claudication (n = 88), and popliteal aneurysm (n = 20). Intensive surveillance of autogenous vein bypasses consisted of ankle brachial index and duplex scan with graft velocities measured at 1 month, 3 months, 6 months, and every 6 months subsequently. After surgery 317 bypasses had intensive surveillance, 222 bypasses were clinically indicated for follow-up, and 76 bypasses were excluded because follow-up or patency was less than 31 days.
  
  
  RESULTS
  Primary patency at 5 years was similar for bypasses treated by intensive surveillance (56%) and those treated with clinically indicated procedures (67%). Secondary patency and limb salvage at 5 years was significantly improved (p < 0.02) for bypasses followed by intensive surveillance (80% and 94%) compared with clinically indicated procedures (67% and 73%). Revision of patent bypasses was higher (p < 0.000001) for bypasses treated by intensive surveillance (61 of 70, 87%) compared with those treated with clinically indicated procedures (9 of 34, 26%). Secondary patency at 2 years was significantly higher (p < 0.02) for revision of patent bypasses (79%) compared with thrombosed bypasses (55%).
  
  
  CONCLUSIONS
  Long-term autogenous vein bypass patency and limb salvage is significantly improved by intensive surveillance, permitting identification and correction of graft threatening lesions before thrombosis.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, KY, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Bergamini
authors.forename: S M
authors.initials: SM
authors.lastname: George
authors.forename: H T
authors.initials: HT
authors.lastname: Massey
authors.forename: P K
authors.initials: PK
authors.lastname: Henke
authors.forename: T W
authors.initials: TW
authors.lastname: Klamer
authors.forename: G E
authors.initials: GE
authors.lastname: Lambert
authors.forename: F B
authors.initials: FB
authors.lastname: Miller
authors.forename: R N
authors.initials: RN
authors.lastname: Garrison
authors.forename: J D
authors.initials: JD
authors.lastname: Richardson
mesh_terms: D000368:Aged; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011182:Postoperative Care; D012086:Reoperation; D016909:Tibial Arteries / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency