Pre-operative hand-held Doppler run-off score can be used to stratify risk prior to infra-inguinal bypass surgery.
OBJECTIVE
to investigate the relationship between calf vessel run-off assessed by hand-held Doppler, graft patency and patient survival following infra-inguinal graft surgery.


METHODS
prospective cohort study of 258 consecutive patients undergoing infra-inguinal bypass grafts in one centre between 1995-99.


METHODS
ankle Doppler auditory waveform characteristics were documented for patients considered for infra-inguinal bypass grafting. Doppler signals from the anterior tibial, posterior tibial and dorsalis pedis arteries were scored triphasic/biphasic (2), monophasic (1) or absent (0). A total Doppler run off score (0-6) was calculated. Following surgery graft surveillance was undertaken using duplex ultrasound at 6, 12, 26 and 52 weeks. Graft and patient survival were analysed using Cox regression analysis.


RESULTS
overall primary assisted graft patency at one year was 80%. With an increasing Doppler score from 0 to 6, primary assisted graft patency steadily rose from 50% to 100% (p = 0.0002), accompanied by a steady fall in patient mortality from 50% to 5% (p = 0.0003).
Stewart
A H R
AH
Vascular Studies Unit, Bristol Royal Infirmary, Bristol, UK.
Lucas
A
A
Smith
F C T
FC
Baird
R N
RN
Lamont
P M
PM
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000295:instrumentation*; D014652:Vascular Diseases / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*