title: Duplex ultrasound criteria for femorofemoral bypass revision.
abstract: OBJECTIVE
  This study was conducted to evaluate the impact of duplex ultrasound surveillance on the patency of femorofemoral bypasses performed for symptomatic peripheral arterial occlusive disease (PAOD).
  
  
  METHODS
  A retrospective review was conducted of 108 patients (78 men, 30 women) with a mean age of 62 +/- 10 years who underwent femorofemoral prosthetic (n = 100) or vein (n = 8) bypass grafting for symptomatic PAOD (claudication, 38%; rest pain, 41%; tissue loss, 11%; infection, 10%) during a 10-year period. Prior or concomitant inflow iliac artery stenting was performed in 26 patients (24%), and a redo femorofemoral bypass was performed in 19 patients (18%). Duplex ultrasound surveillance of the reconstruction was performed at 6-month intervals to assess patency, graft (midgraft peak systolic flow velocity) hemodynamics, and identify inflow or outflow stenotic lesions. Repair was recommended for a stenosis with a peak systolic velocity (PSV) >300 cm/s and a PSV ratio >3.5. Life-table analysis was used to estimate primary, assisted-primary, and secondary graft patency.
  
  
  RESULTS
  During a mean 40-month follow-up (range, 2 to 120 months), 31 bypasses (29%) were revised: 19 duplex-detected stenosis involving the inflow iliac artery (n = 15) or anastomotic stenosis (n = 4), or both, 11 for graft thrombosis, and 1 for graft infection. Abnormal inflow iliac (PSV >300 cm/s) hemodynamics or a mid-graft PSV <60 cm/s was measured in eight of 11 grafts before thrombosis. Mean time to revision was 30 +/- 17 months. The primary graft patency at 1, 3, and 5 years was 86%, 78%, and 62%, respectively. Correction of duplex-detected stenosis resulted in assisted-primary patency of 95% at 1 year and 88% at 3 and 5 years (P < .0001, log-rank). Secondary graft patency was 98% at 1 year and 93% at 3 and 5 years.
  
  
  CONCLUSIONS
  Vascular laboratory surveillance after femorofemoral bypass that included duplex ultrasound imaging of the inflow iliac artery and graft accurately identified failing grafts. A duplex-detected identified stenosis with a PSV >300 cm/s correlated with failure, and repair of identified lesions was associated with excellent 5-year patency.
authors.affiliation: Division of Vascular & Endovascular Surgery, University of South Florida College of Medicine, Tampa, 33606, USA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.forename: Paul A
authors.initials: PA
authors.lastname: Armstrong
authors.forename: Dennis F
authors.initials: DF
authors.lastname: Bandyk
authors.forename: W Brent
authors.initials: WB
authors.lastname: Keeling
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Flaherty
authors.forename: Murray L
authors.initials: ML
authors.lastname: Shames
authors.forename: Brad L
authors.initials: BL
authors.lastname: Johnson
authors.forename: Martin R
authors.initials: MR
authors.lastname: Back
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation; D003251:Constriction, Pathologic; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D015993:Life Tables; D008875:Middle Aged; D012086:Reoperation; D018608:Ultrasonography, Doppler; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency; D014656:Vascular Surgical Procedures