Femorodistal vein grafts: the utility of graft surveillance criteria.
OBJECTIVE
This retrospective review of femorodistal vein grafts was analyzed to determine the usefulness of various graft surveillance criteria.


METHODS
The surveillance schedule involved evaluations at 1 month, every 3 months the first year, and then every 6 months. Salvage intervention or graft occlusion occurring within the next follow-up interval defined surveillance end points. One hundred two grafts (329 surveillance visits) had an ankle/brachial index (ABI). A duplex scanning-determined midgraft peak systolic flow velocity (PSFV) was available for 81 grafts (262 visits). Forty-eight grafts (137 visits) had both a PSFV and entire graft duplex scanning (EGDS) to determine stenosis greater than 50%, whereas 40 grafts (91 visits) had simultaneous ABI and EGDS.


RESULTS
When a greater than 15% decrease in ABI denoted an abnormal surveillance study result, a positive predictive value (PPV) of 24.3% and negative predictive value of 94.5% were noted. Similarly, a PSFV cutoff of less than 35 cm/sec demonstrated values of 26.3% and 94.2%, respectively. When an EGDS of greater than 50% stenosis or a PSFV of less than 35 cm/sec were the cutoff criteria, the PPV was 36.7% and negative predictive value 99.1%, whereas characterizing abnormal results further with ABI (> 15% decreases) increased the PPV to 83.3%.


CONCLUSIONS
The combination of an EGDS, midgraft PSFV, and ABI provides optimal follow-up for our patients with a femorodistal vein graft.
Dalsing
M C
MC
Indiana University Medical Center, Indianapolis 46202.
Cikrit
D F
DF
Lalka
S G
SG
Sawchuk
A P
AP
Schulz
C
C
D000842:Ankle / Q000098:blood supply; D001783:Blood Flow Velocity; D001794:Blood Pressure; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014680:Veins / Q000637:transplantation