Rationale and Benefits of Surveillance After Prosthetic Infrainguinal Bypass Grafts

  • Stephen KolakowskiJr
  • Keith D. Calligaro
  • Sandy McAffe-Benett
  • Kevin J. Doerr
  • Kathy Mueller
  • Matthew J. Dougherty


Infrainguinal revascularization with autogenous conduit remains the gold standard of care for the treatment of critical lower extremity ischemia when bypass is required. One of the major factors diminishing long-term patency of these grafts is the development of stenosis of the graft or inflow and outflow arteries.Twenty to forty percent of all infrainguinal bypass grafts will develop stenosis due to different factors.1 It is critical to identify these lesions while grafts are patent, as treatment with minor procedures will maintain patency, while treatment after thrombosis is significantly more morbid and less successful. Clinical examination looking for signs and symptoms of limb ischemia, including pulse evaluation and with measurement of ankle systolic pressure, can usually identify only the very high grade stenoses or occlusions. Over the past two decades there has been increasing evidence to support postoperative surveillance of arterial bypass grafts to improve long-term patency. The use of duplex ultrasound (DU) surveillance for infrainguinal vein grafts has become widely accepted.2 We have suggested that DU is also applicable for prosthetic bypass grafts.3


Bypass Graft Vein Graft Peak Systolic Velocity Primary Patency Graft Patency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Ryan SV, Dougherty MJ, Chang M, Lombardi J, Raviola C, Calligaro K. Abnormal duplex findings at the proximal anastomosis of infrainguinal bypass grafts: Does revision enhance patency? Ann Vasc Surg 2001;15:98–103.CrossRefPubMedGoogle Scholar
  2. 2.
    Lundell A, Lindblad B Bergqvist D, Hansen F. Femoropopliteal-crural graft patency is improved by an intensive surveillance program: A prospective randomized study J Vasc Surg 1995;21:26–33.CrossRefPubMedGoogle Scholar
  3. 3.
    Calligaro KD, Doerr K, McAffee-Bennett S, Krug R, Raviola CA, Dougherty MJ. Should duplex ultrasonography be performed for surveillance of femoropopliteal and femorotibial arterial prosthetic bypasses? Ann Vasc Surg 2001;15:520–524.CrossRefPubMedGoogle Scholar
  4. 4.
    Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: Revised version. J Vasc Surg 1997;26:517.CrossRefPubMedGoogle Scholar
  5. 5.
    Sanchez LA, Suggs WD, Veith FJ, et al. Is surveillance to detect failing polytetrafluoroethylene bypasses worthwhile? Am J Surg 1993;18:981–990.Google Scholar
  6. 6.
    Veith FJ, Gupta SK, Ascer E, et al. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg 1986;3:104–114.CrossRefPubMedGoogle Scholar
  7. 7.
    Mills JL, Harris EJ, Taylor LM, Beckett Wc. The origin of infrainguinal vein graft stenosis: A prospective study based duplex surveillance. J Vasc Surg 1995;21:16–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Idu MM, Blankenstein JD, de Gier P, et al. Impact of color-flow duplex surveillance program on infrainguinal vein graft patency:A five-year experience. J Vasc Surg 1993;17:42–53.CrossRefPubMedGoogle Scholar
  9. 9.
    Lundell A, Linblad B, Bergqvist D, et al. Femoropoplitealcrural graft patency is improved by an intensive surveillance program: A prospective randomized study. J Vasc Surg 1995;21:26–34.CrossRefPubMedGoogle Scholar
  10. 10.
    Mattos MA, van Bemmelen PS, Hodgson KJ, et al. Does correction of stenoses identified with color duplex scanning improve infrainguinal graft patency? J Vasc Surg 1993:17:54–66.CrossRefPubMedGoogle Scholar
  11. 11.
    Dougherty MJ, Calligaro KD, Delaurentis DA. The natural history of “failing” arterial bypass grafts in a duplex surveillance protocol. Ann Vasc Surg 1998;12:255–259.CrossRefPubMedGoogle Scholar
  12. 12.
    Rhodes JM, Gloviczki P, Bower TC, Panneton JM, Canton LG, Toomey BJ. The benefits of secondary interventions in patients with failing or failed pedal bypass grafts. Am J Surg 1999;178:151–155.CrossRefPubMedGoogle Scholar
  13. 13.
    Wixon CL, Mills JL,Westerband A, Hughes JD, Ihnat DM. An economic appraisal of lower extremity bypass graft maintenance. J Vasc Surg 2000;32:1–12.CrossRefPubMedGoogle Scholar
  14. 14.
    Moody P, Gould DA, Harris PL. Vein graft surveillance improves patency in femoropopliteal bypass. Eur J Vasc Surg 1990;4:117–121.CrossRefPubMedGoogle Scholar
  15. 15.
    Disselhoff B, Bluth J, Jakimowicz J. Early detection of stenosis of femoral-distal grafts: A surveillance study using color-duplex scanning. Eur J Vasc Surg 1989;3:43–48.CrossRefPubMedGoogle Scholar
  16. 16.
    Barnes RW, Thompson BW, MacDonald CM, et al. Serial noninvasive studies do not herald postoperative failure of femoropopliteal or femorotibial bypass grafts. Ann Surg 1989;210:486–492.PubMedCrossRefGoogle Scholar
  17. 17.
    Berkowitz J, Hobbs C, Roberts B, et al. Value of routine vascular laboratory studies to identify vein graft stenoses. Surgery 1981;90:971–979.PubMedGoogle Scholar
  18. 18.
    Bandyk DF, Cato RF, Towne JB. A low flow velocity predicts failure of femoropopliteal and femorotibial bypass grafts. Surgery 1985;98:799–809.PubMedGoogle Scholar
  19. 19.
    Mills JL, Harris EJ, Taylor LM Jr, 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;12:379–386; discussion 387–389.CrossRefPubMedGoogle Scholar
  20. 20.
    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;40:724–730; discussion 730–731.CrossRefPubMedGoogle Scholar
  21. 21.
    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;9:284–296.CrossRefGoogle Scholar
  22. 22.
    Strandness DE, Andros G, Bake D, et al. Vascular laboratory utilization and payment report of the Ad Hoc Committee of the Western Vascular Society. J Vasc Surg 1992;16: 163–168.CrossRefPubMedGoogle Scholar
  23. 23.
    Lalak NJ, Hanel KC, Junt J, et al. Duplex scan surveillance of infrainguinal prosthetic bypass grafts. J Vasc Surg 1994;20:637–641.PubMedGoogle Scholar
  24. 24.
    Providers’ News. April 1, 1993. Medicare Services, Louisiana.Google Scholar
  25. 25.
    Baker JD. The vascular laboratory: Regulations and other challenges. J Vasc Surg 1994;19:901–904.PubMedGoogle Scholar
  26. 26.
    TASC Working Group. Management of peripheral arterial disease. J Vasc Surg 2000;31:S1–S296.CrossRefGoogle Scholar
  27. 27.
    Hobollah JJ, Nassal MM, Ryan SM, et al. Is color duplex surveillance of infrainguinal polytetrafluoroethylene grafts worthwhile? Am J Surg 1997;174:131–135.CrossRefGoogle Scholar
  28. 28.
    Fasih T, Rudol G, Ashour H, Mudawi A, Bhattacharya V. Surveillance versus nonsurveillance for femoro-popliteal bypass grafts. Angiology 2004;55(3):251–256.CrossRefPubMedGoogle Scholar
  29. 29.
    Lundell A, Lindblad B, Bergqvist D, Hansen F. Femoropopliteal-crural graft patency is improved by an intensive surveillance program: A prospective randomized study. J Vasc Surg 1995;21:26–33.CrossRefPubMedGoogle Scholar
  30. 30.
    Calligaro KD, Musser DJ, Chen AY, et al. Duplex ultrasonography to diagnose arterial prosthetic grafts. Surgery 1996;120:455–459.CrossRefPubMedGoogle Scholar
  31. 31.
    Sanchez LA, Gupta SK, Veith FJ, et al. A ten-year experience with one hundred fifty failing or threatened vein polytetrafluoroethylene arterial bypass grafts. J Vasc Surg 1991;14:729–738.CrossRefPubMedGoogle Scholar
  32. 32.
    Sullivan KL, Gardiner GA Jr, Kandarpa K, Bonn J, Shapiro MJ, Carabasi RA, Smullens S, Levin DC. Efficacy of thrombolysis in infrainguinal bypass grafts. Circulation. 1991;83(2 Suppl):I99–105.PubMedGoogle Scholar
  33. 33.
    Bandyk DF. Infrainguinal vein bypass graft surveillance: How to do it, when to intervene, and is it cost-effective?. J Am Coll Surg 2002;194(1 Suppl):S40–52.CrossRefPubMedGoogle Scholar
  34. 34.
    Nyamekye I, Sommerville K, Raphael M, Adiseshiah M, Bishop C. Non-invasive assessment of arterial stenoses in angioplasty surveillance: A comparison with angiography. Eur J Vasc Endovasc Surg 1996;12:471–481.CrossRefPubMedGoogle Scholar
  35. 35.
    Buth J, Disselhoff B, Sommeling C, et al. Color-flow duplex criteria for grading stenosis in infrainguinal vein grafts. J Vasc Surg 1991;14:716–728.CrossRefPubMedGoogle Scholar
  36. 36.
    Grigg MJ, Nicolaides AN, Wolfe JHN. Detection and grading of femorodistal vein graft stenoses: Duplex velocity measurements compared with angiography. J Vasc Surg 1988;8:661–666.CrossRefPubMedGoogle Scholar
  37. 37.
    Bergamini TM, George SM, Massey HT, et al. Intensive surveillance of femoropopliteal-tibial autogenous vein bypasses improves long-term graft patency and limb salvage. Ann Surg 1995;221:507–516.CrossRefPubMedGoogle Scholar
  38. 38.
    Gahtan V, Payne LP, Roper LD, et al. Duplex criteria for predicting progression of vein graft lesions: Which stenoses can be followed? J Vasc Tech 1995;19:211–215.Google Scholar
  39. 39.
    Belkin M, Schwartz LB, Donaldson MC, et al. Hemodynamic impact of vein graft stenoses and their prediction in the vascular laboratory. J Vasc Surg 1997;25:1016–1022.CrossRefPubMedGoogle Scholar
  40. 40.
    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
  41. 41.
    Bandyk DF, Johnson BL, Gupta AK, et al. Nature and management of duplex abnormalities encountered during infrainguinal vein bypass grafting. J Vasc Surg 1996;24:430–438.CrossRefPubMedGoogle Scholar
  42. 42.
    Caps MT, Cantwell-Gab K, Bergelin RO, et al. Vein graft lesions: Time of onset and rate of progression. J Vasc Surg 1995;22:466–474.CrossRefPubMedGoogle Scholar
  43. 43.
    Chalmers RT, Hoballah JJ, Kresowik TF, et al. The impact of color duplex surveillance on the outcome of lower limb bypass with segments of arm veins. J Vasc Surg 1994;19:279–286.PubMedGoogle Scholar
  44. 44.
    Gupta AK, Bandyk DF, Cheanvechai D, et al. Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique. J Vasc Surg 1997;25:211–220.CrossRefPubMedGoogle Scholar
  45. 45.
    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
  46. 46.
    Idu MM, Buth J, Hop WC, et al. Vein graft surveillance: Is graft revision without angiography justified and what criteria should be used? J Vasc Surg 1998;27:399–411.CrossRefPubMedGoogle Scholar
  47. 47.
    Dougherty MJ, Calligaro KD, DeLaurentis DA. Revision of failing lower extremity bypass grafts. Am J Surg 1998;178:126–130.CrossRefGoogle Scholar
  48. 48.
    Erickson CA, Towne JB, Seabrook GR, Freischlag JA, Cambria RA. Ongoing vascular laboratory surveillance is essential to maximize long-term in situ saphenous vein bypass patency. J Vasc Surg 1996;23:18–26.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2010

Authors and Affiliations

  • Stephen KolakowskiJr
    • 1
  • Keith D. Calligaro
    • 1
  • Sandy McAffe-Benett
    • 1
  • Kevin J. Doerr
    • 1
  • Kathy Mueller
    • 1
  • Matthew J. Dougherty
    • 1
  1. 1.Section of Vascular SurgeryPennsylvania HospitalPhiladelphiaUSA

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