Is early postoperative duplex scan surveillance of leg bypass grafts clinically important?

Abstract

Despite normal completion arteriography, early graft velocity abnormalities are strikingly common and were detected in 26% of the 224 infrainguinal vein grafts in this series. These lesions were clinically important because 52% necessitated revision. Surprisingly, however, 38% of these early flow disturbances resolved, despite a PSV of more than 300 cm/s in 27% of cases. Early duplex scan surveillance singularly detects a clinically significant subgroup of grafts that need revision. The possible origin of these early lesions deserves further inquiry, but on the basis of its clinical yield, we recommend that early duplex scan surveillance of infrainguinal bypass grafts should be routine and should be considered for Medicare reimbursement.

Balloon angioplasty for revision of failing lower extremity bypass grafts

“…1 Accumulating data have validated the utility of color duplex ultrasound (CDU) scanning to detect hemodynamically significant abnormalities of infrainguinal arterial bypass grafts, 8,[11][12][13] the rationale being that correction of stenotic lesions is likely to improve graft patency and reduce the risk of amputation. [14][15][16] Considerable uncertainty still exists about the optimal management of these threatened bypass grafts once they are identified. 17 Determining the utility of any treatment for failing grafts is made difficult by the variety of treatment options, the frequent multiplicity of lesions, and specific lesion characteristics, including length, location, and temporal development after graft implantation.…”

Patency of infra-inguinal vein grafts – effect of intraoperative Doppler assessment and a graft surveillance program

“…7 Despite this, angiography only offers a 2D image, and up to 25% of grafts with a normal completion angiogram have haemodynamic abnormalities detected by an early duplex scan. 17 Furthermore, completion angiography has not been shown to alter short-or intermediateterm graft patency. 10 Angioscopy had its proponents in the 1990s 8 and proved more useful in assessing the quality of the venous conduit than angiography but has fallen out of favor, largely due to the inability to adequately assess the distal vasculature.…”

Successful infrainguinal revascularization with autologous vein for inadvertent stripping of superficial femoral artery: a case report

“…The testing frequency should be individualized to the patient, the type of arterial bypass, and duplex scan findings [18]. It is recommended that early surveillance of the duplex scan or ultrasonographic contrast become integral parts of the postoperative follow up of infrainguinal vein bypass grafts [19], but the latter is preferred due to the increased accuracy of the diagnosis of patency of leg arteries and diminished time necessary for the execution of duplex scanning [20].…”