Graft stenosis: Justification for 1-year surveillance

Abstract

In all, 412 femorodistal grafts (femoropopliteal and femorocrural), performed between 1984 and 1988, have been prospectively studied at 6 weeks and 3, 6, 9 and 12 months after operation and at intervals of 6 months thereafter by duplex scanning and intravenous digital subtraction angiography. The overall incidence of stenoses was 16 per cent (femorocrural 20 per cent, femoropopliteal 15 per cent). All stenoses were detected in the first year after operation and none occurred after this. Twenty-four non-haemodynamically significant stenoses were not treated but were followed at intervals of 3 months. Forty-two haemodynamically significant stenoses were detected and secondary procedures were performed in 30 grafts at a mean of 8 months after surgery. Thirteen had percutaneous balloon dilatation and six (46 per cent) remain patent at a mean follow-up of 22 months. Two grafts which occluded within 30 days and three which restenosed at a mean of 8 months had tertiary procedures. Seventeen grafts were surgically revised, nine with patch grafts and eight with bypass grafts. Eleven of these remain patent at a mean follow-up of 30 months. One occluded immediately and three occluded late. Two grafts which restenosed at a mean of 19 months had successful tertiary procedures. In total, seven grafts had tertiary procedures (two had balloon dilatation and five had surgery) and six of these remain patent at a mean follow-up of 13.5 months. In conclusion, 37 procedures have been performed on 30 grafts, of which 23 (77 per cent) remain patent at a mean follow-up of 12 months. Approximately one-quarter of femorodistal grafts will develop graft-related stenoses and graft surveillance is worthwhile, but only for the first year after operation.

Vein Graft Stenosis and the Heparin Responsiveness of Human Vascular Smooth Muscle Cells

“…Although the basic features of MIH are well described, it is unclear why this process, which is essentially a reactive response to vascular injury, 31,32 becomes excessive and inappropriate in 25% to 50% of patients 6 and leads to clinically significant luminal obstruction. Many therapeutic agents have proved to be highly effective in attenuating MIH after vascular injury in animal models, but this has not been predictive of success in clinical trials, which have been consistently negative.…”

“…Among this group, Ϸ30% are likely to develop MIH lesions severe enough to cause clinically significant graft stenoses. 6 We therefore set up a prospective study to investigate whether the proliferative responses of cultured VSMCs to heparin predicted the subsequent development of infrainguinal graft stenoses.…”

“…It is responsible for Ϸ80% of all peripheral arterial bypass graft failures, 6 resulting in the loss of Ϸ30% of all arterial bypass grafts. MIH comprising VSMC proliferation (and migration) with deposition of extracellular matrix is one major cause of the stenoses that develop between 6 weeks and 1 year after vessel injury.…”

Desarrollo de un sistema de telemetría para el seguimiento postoperatorio de procedimientos en cirugía vascular: modelo in vitro

“…Sin embargo, en una serie de 46 pacientes con un ratio mayor de 3, sólo 14 se revisaron y tan sólo 3 se ocluyeron durante el seguimiento (53) . El grupo de…”

“…Davies et al, al igual que otros grupos, recomiendan focalizar el seguimiento durante el primer año postoperatorio ya que es el periodo con mayor frecuencia de re-estenosis (31,53,54) . Sin embargo, existe evidencia de una incidencia anual del 2-3% de lesiones de nueva aparición durante el seguimiento (55,67) , por lo que grupos como el de Leicester proponen un seguimiento indefinido de los injertos venosos infrainguinales (68) .…”