Rationale and Benefits of Surveillance After Prosthetic Infrainguinal Bypass Grafts
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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
KeywordsBypass Graft Vein Graft Peak Systolic Velocity Primary Patency Graft Patency
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- 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
- 24.Providers’ News. April 1, 1993. Medicare Services, Louisiana.Google Scholar
- 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