Duplex Surveillance of Infrainguinal Bypass Grafts
Vascular laboratory surveillance using duplex ultrasound is recommended after infrainguinal bypass grafting as it benefits patient outcome by improving graft patency.1,2 Ideally, duplex testing should begin in the operating room to survey the graft and anastomotic sites for stenosis and to document augmented flow in the runoff arteries and foot. Color duplex imaging is more sensitive than arteriography for intraoperative assessment and detects unrecognized graft abnormalities in 5–10% of reconstructions, permitting immediate correction.3 The application of duplex graft surveillance has been shown to reduce the incidence of both early (<30 days) and late bypass failure.1,2,4 Infrainguinal arterial bypasses, constructed of either autologous vein or a prosthetic graft, are prone to develop intrinsic stenotic lesions, which when progressive to cause thrombosis if graft flow is reduced below the “thrombotic threshold velocity.”5–9 Myointimal hyperplasia producing lumen reduction is the most common etiology for graft stenosis, but its temporal occurrence and site(s) of development differ between vein and prosthetic grafts. The occurrence of vein graft stenosis is highest in the 6 months following the procedure, and decreases thereafter. Myointimal stenosis is most common at vein valve and anastomotic sites, and has anatomic features of a smooth, typically focal (<2 cm) stricture. This acquired lesion has been implicated in nearly 80% of vein bypass failures, with other graft failures caused by technical errors, intrinsic graft lesions, or hypercoagulable states.1,2,6,10 Following prosthetic grafting, intragraft abnormalities are rare (<10% of all stenoses) with graft stenosis developing most commonly at the distal anastomosis and the adjacent runoff artery. The failure rate of prosthetic grafts (10–15%/year) is higher than autologous vein grafts (2–5%/year) and has been attributed to differences in “thrombotic threshold velocity,” myointimal hyperplasia development, and atherosclerotic disease progression.8,9
KeywordsVein Graft Peak Systolic Velocity Prosthetic Graft Graft Thrombosis Graft Stenosis
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Bandyk DF, Schmitt DD, Seabrook GR, et al.
Monitoring functional patency of in situ saphenous vein bypasses: The impact of a surveillance protocol and elective revision. J Vasc Surg 1989;11:280–294.Google Scholar
Moody AP, Gould DA, Harris PL. Vein graft surveillance improves patency in femoropopliteal bypass. Eur J Vasc Surg 1990;4:117–120.CrossRefPubMedGoogle Scholar
Bandyk DF, Mills JL, Gahtan V, et al.
Intraoperative duplex scanning of arterial reconstructions: fFate of repaired and unrepaired defects. J Vasc Surg 1994;20:426–433.PubMedGoogle Scholar
Bandyk DF, Johnson BL, Gupta AK, Esses GE. Nature and management of duplex abnormalities encountered during infrainguinal vein bypass grafting. J Vasc Surg 1996;24:430– 436.CrossRefPubMedGoogle Scholar
Taylor PR, Wolfe HN, Yyrrell MR, et al.
Graft stenosis: Justification for 1-year surveillance. Br J Surg 1990;77:1125– 1128.CrossRefPubMedGoogle Scholar
Mills JL, Harris EJ, Taylor LM, et al.
The importance of routine surveillance of distal bypass grafts with duplex scanning: A study of 379 reversed vein grafts. J Vasc Surg 1990;12:379–389.CrossRefPubMedGoogle Scholar
Lundell A, Linblad B, Bergqvist D, Hansen F. Femorpopliteal graft patency is improved by an intensive surveillance program: A prospective randomized study. J Vasc Surg 1995;21:26–34.CrossRefPubMedGoogle Scholar
Lawlike NJ, Hanel KC, Hunt J, et al.
Duplex scan surveillance of infrainguinal prosthetic bypass grafts. J Vasc Surg 1994;20:637–641.Google Scholar
Calligaro KD, Musser DJ, Chen AY, et al.
Duplex ultrasonography to diagnose failing arterial prosthetic grafts. Surgery 199;120:455–459.Google Scholar
Gupta AK, Bandyk DF, Cheanvechai D, Johnson BL. Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique. J Vasc Surg 1997;25:211–225.CrossRefPubMedGoogle Scholar
Mills JL, Bandyk DF, Gahtan V, Esses GE. The origin of infrainguinal vein graft stenosis: A prospective study based on duplex surveillance. J Vasc Surg 1995;21:16– 25.CrossRefPubMedGoogle Scholar
Giannoukas AD, Adrouulakis AE, Labropoulos N, Wolfe JHN. The role of surveillance after infrainguinal bypass grafting. Eur J Vasc Endovasc Surg 1996;11:279–289.CrossRefPubMedGoogle Scholar
Idu MM, Blankenstein JD, de Gier P, Truyen E, Buth J. Impact of a color-flow duplex surveillance program on infrainguinal vein graft patency: A five-year experience. J Vasc Surg 1993;17:42–53.CrossRefPubMedGoogle Scholar
Bandyk DF, Bergamini TM, Towne JB, et al.
Durability of vein graft revision: The outcome of secondary procedures. J Vasc Surg 1991;13:200–210.CrossRefPubMedGoogle Scholar
Donaldson MC, Mannick JA, Whittemore AD. Causes of primary graft failure after in situ saphenous vein bypass grafting. J Vasc Surg 1991;13:137–149.CrossRefGoogle Scholar
Bergamini TM, Towne JB, Bandyk DF, et al.
Experience with in situ saphenous vein bypass during 1981 to 1989: Determinant factors of long-term patency. J Vasc Surg 1991; 13:97–106.Google Scholar
Johnson BL, Bandyk DF, Back MR, Avino AJ, Roth SM. Intraoperative duplex monitoring of infrainguinal vein bypass procedures. J Vasc Surg 2000;31:678–690.CrossRefPubMedGoogle Scholar
Armstrong PA, Bandyk DF, Wilson JS, Shames ML, Johnson BL, Back MR. Optimizing infrainguinal arm vein bypass patency with duplex ultrasound surveillance and endovascular therapy. J Vasc Surg 2004;40:724– 731.CrossRefPubMedGoogle Scholar
Bandyk DF, Kaebnick HW, Bergamini TM, et al.
Hemodynamics of in situ saphenous vein arterial bypass. Arch Surg 1988;123:477–482.PubMedGoogle Scholar
Bandyk DF, Seabrook GR, Moldenhaurer P, et al.
Hemodynamics of vein graft stenosis. J Vasc Surg 1988;8:688–695.CrossRefPubMedGoogle Scholar
Belkin M, Mackey WC, Maclaughlin R, et al.
The variation in vein graft flow velocity with luminal diameter and outflow level. J Vasc Surg 1992;15:991–999.CrossRefPubMedGoogle Scholar
Mills JL, Fujitani RM, Taylor SM. The contribution of routine intraoperative completion arteriography to early graft patency. Am J Surg 1992;164:506–511.CrossRefPubMedGoogle Scholar
Miller Maracaccio EJ, Tannerbaum GE, et al.
Comparison of angioscopy and angiography for monitoring infrain- guinal bypass grafts: Result of a prospective randomized trial. J Vasc Surg 1993;17:382–398.CrossRefGoogle Scholar
Rzucidlo EM,Walsh DB, Powell RJ, Zwolak RM, Fillinger MF, Schermerhorn ML, Cronenwett JL. Prediction of early graft failure with intraoperative completion duplex ultrasound scan. J Vasc Surg 2002;36:975–981.CrossRefPubMedGoogle Scholar
Giswold ME, Landry GJ, Sexton GJ, Yeager RA, Edwards JM, Taylor LM, Moneta GL. Modifiable patient factors associated with reverse vein graft occlusion in the era of duplex scan surveillance. J Vasc Surg 2003;37:47–53.CrossRefPubMedGoogle Scholar
Gahtan V, Payne LP, Roper LD, et al.
Duplex criteria for predicting progression of vein graft lesions. J Vasc Tech 1995;19:211–215.Google Scholar
Westerband A, Mills JL, Kistler S, et al.
Prospective validation of threshold criteria for intervention in infrainguinal vein grafts undergoing duplex surveillance. Ann Vasc Surg 1997;11:44–48.CrossRefPubMedGoogle Scholar
Caps T, Cantwell-Gab, K, Bergelin RO, Strandness DE. Vein graft lesions: Time of onset and rate of progression. J Vasc Surg 1995;22:466–475.CrossRefPubMedGoogle Scholar
Mills et al.
Mills JL, Wixon CL, James DC, Devine J, Westerband A, Hughes JU. The natural history of intermediate and critical vein graft stenosis: Recommendations for continued surveillance or repair. J Vasc Surg 2001;33:273– 280.Google Scholar
Sladen JG, Reid JDS, Cooperberg PL, et al.
Color flow duplex screening of infrainguinal grafts combining low and high-velocity criteria. Am J Surg 1989;158:107– 112.CrossRefPubMedGoogle Scholar
Papanicoloauo G, Zierler RE, Beach RW, et al.
Hemodynamic parameters of failing infrainguinal bypass grafts. Am J Surg 1995;169:238–244.CrossRefGoogle Scholar
Buth J, Disselhoff B, Sommeling C, et al.
Color flow duplex criteria for grading stenosis in infrainguinal vein grafts. J Vasc Surg 1991;14:729–738.CrossRefGoogle Scholar
Bell P, et al.
At what PSV ratio value should grafts be revised. Eur J Vasc Endovasc Surg 1998;15:258–261.CrossRefPubMedGoogle Scholar
Avino AJ, Bandyk DF, Gonsalves AJ, Johnson BL, Black TJ, Zwiebel BR, Rahaim MJ, Cantor A. Surgical and endovascular intervention for infrainguinal vein graft stenosis. J Vasc Surg 1999;29:60–71.CrossRefPubMedGoogle Scholar
Alexander JQ, Katz SG. The efficacy of percutaneous transluminal angioplasty in the treatment of infrainguinal vein bypass graft stenosis. Arch Surg 2003;138:510–513.CrossRefPubMedGoogle Scholar
Kasirajan K, Schneider PA. Early outcome of “cutting” balloon angioplasty for infrainguinal vein graft stenosis. J Vasc Surg 2004;39:702–708.CrossRefPubMedGoogle Scholar
Erickson CA, Towne JB, Seabrook GR, et al.
Ongoing vascular laboratory surveillance is essential to maximize long term in situ saphenous vein bypass patency. J Vasc Surg 1996;23:18–27.CrossRefPubMedGoogle Scholar
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