Vein graft lesions: Time of onset and rate of progression

Abstract

The data support the performance of a duplex scan either during surgery or before discharge from the hospital in addition to frequent surveillance for the first 6 months. Frequent surveillance is appropriate for lesions with less than 75% diameter reduction as long as they remain asymptomatic and without a significant reduction in the ankle-brachial index.

Efficacy of duplex ultrasound surveillance after infrainguinal vein bypass may be enhanced by identification of characteristics predictive of graft stenosis development

“…[9][10][11] These "residual" graft abnormalities have a different natural history from "de novo" stenosis with higher likelihood to progress to a severe stenosis, and graft thrombosis rate. 12 Our review demonstrated 40% of the bypasses had an abnormality identified on the first duplex surveillance scan consisting primarily of a region of elevated PSV and lumen reduction. This characteristic was highly predictive of subsequent graft revision at 3 years primary patency of 64% if normal vs 28% if abnormal; and was identified more frequently than clinical series composed primarily of singlesegment reversed saphenous vein bypass (25% incidence using similar duplex criteria).…”

“…Our experience and that of other vascular groups with expertise in vascular laboratory testing support the routine use of duplex ultrasound after infrainguinal vein bypass. [4][5][6][11][12][13][14][15] All patients should be evaluated using duplex ultrasound within several weeks of successful bypass grafting to identify residual graft defects and if specific risks are present, ie, non-single segment saphenous vein bypass, redo bypass, un-controlled atherosclerotic risk factors (tobacco abuse) have repeat graft imaging 3 to 4 months later after graft arterialization and wound healing has occurred. Other clinical trials have found bypass grafting for CLI, vein diameter Ͻ3 mm, and graft lengths Ͼ50 cm to be "risk-factors" for graft failure and associated with a twotime increase in the number re-interventions within 1 year of bypass grafting.…”

Critical limb ischemia

“…Clinically significant lesions of intimal hyperplasia generally occur 6 to 12 months postoperatively. Most graft abnormalities (more than 85%) will be found by 6 months [29]. The incidence of new graft lesions from intimal hyperplasia is low after 12 months.…”

Peripheral Vascular Disease

“…The areas where research needs to be done are with angioplasty, with or without stents, and the use of venous bypass grafts, both of which are easily studied by ultrasonic methods. 49,89 Work on 3D ultrasonic imaging that can quantify both the sites of restenosis, as well as monitor changes over time, will permit a realistic look at this problem. While it is clear that thrombolysis is useful for therapy of acute embolic events, its role in the therapy of chronic, occlusive arterial disease remains an important issue.…”