The origin of infrainguinal vein graft stenosis: A prospective study based on duplex surveillance

• Published in: Journal of vascular surgery 1995, Vol.21 (1), p.16-25
• Main Authors: Mills, Joseph L., Bandyk, Dennis F., Gahtan, Vivian, Esses, Glenn E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Blood Flow Velocity; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - physiopathology; Humans; Leg - blood supply; Male; Middle Aged; Prospective Studies; Ultrasonography; Veins - transplantation
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/S0741-5214(95)70240-7

Purpose: The purpose of this study was to determine the origin of vein graft lesions and their propensity for progression based on prospective duplex surveillance of 135 infrainguinal vein bypasses. Methods: One hundred sixteen greater saphenous, 13 spliced, five cephalic, and one superficial femoral vein grafts were evaluated by color duplex imaging at surgical procedure, 1 and 6 weeks, 3 and 6 months, and every 3 to 6 months thereafter. Duplex-identified lesions were graded by peak systolic velocity and velocity ratio criteria and were either followed or subjected to revision. Results: Early postoperative duplex surveillance allowed stratification of infrainguinal grafts into two subsets. Of 91 (67%) grafts with normal early scans (at 3 months), only two (2.2%) developed de novo stenoses (at 6 and 8 months) that required revision. Forty-four grafts with abnormal duplex scans had a focal flow abnormality (peak systolic velocity >150 cm/sec, velocity ratio >1.5) in the graft body ( n = 24) or anastomotic region ( n = 20). In 14 grafts the flow abnormality (mean peak systolic velocity = 217 cm/sec, velocity ratio = 2.3) normalized. Ten additional grafts exhibited a moderate, persistent graft stenosis (mean peak systolic velocity 248 cm/sec, velocity ratio = 3.3) that was not repaired. All 20 grafts with lesions that progressed to high-grade stenosis (mean peak systolic velocity = 362 cm/sec, velocity ratio = 7.2) and were revised had a residual flow abnormality confirmed at operation, or it appeared by 6 weeks. In the entire series six (4.4%) grafts failed during the mean 12-month follow-up interval (range 3 to 30 months), 4 with unrepaired defects and two after revision. Conclusions: Prospective duplex surveillance verified that de novo graft stenosis was uncommon (