Have the results of infrainguinal bypass improved with the widespread utilisation of postoperative surveillance?
OBJECTIVE
The objectives of this study were to assess the impact of Duplex surveillance on the results of infrainguinal vein grafts. A review has been performed comparing the outcome of vein grafts undergoing Duplex surveillance plus prophylactic treatment of stenoses to that of vein grafts followed clinically.


METHODS
Only studies providing information on occlusion rates were included. Mortality and limb salvage rates were also analysed but were not available from all studies.


RESULTS
2680 surveillance and 3969 non-surveillance vein grafts were analysed. There was no significant difference between the two groups with respect to presence of critical ischaemia (p=0.3) and level of distal anastomosis (p>0.5). Surveillance identified 493 stenoses in 469 (19%) grafts, 397 (16%) grafts were treated by surgery (248; 62%) and angioplasty (149; 38%). Ninety-eight (26%) grafts developed recurrent stenoses. Total number of deaths, total number of occluded grafts and number of occlusions after 30 days were significantly greater for the non-surveillance group (p<0.001; p<0.001; p<0.01). Perioperative occlusion rates were not significantly different (p=0.1). Few surveillance studies reported limb salvage rates (6 of 17). The numbers of amputations were not significantly different between the two groups (p>0.5).


CONCLUSIONS
The patency of infrainguinal vein grafts would appear to be improved as a result of surveillance. However, no improvement in limb salvage has been demonstrated.
Golledge
J
J
Department of Surgery, Charing Cross and Westminster Medical School, London, U.K.
Beattie
D K
DK
Greenhalgh
R M
RM
Davies
A H
AH
D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D005263:Femoral Artery / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D007866:Leg / Q000098:blood supply; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery; D011182:Postoperative Care; D018616:Ultrasonography, Doppler, Duplex; D014680:Veins / Q000637:transplantation