Diagnosis and Treatment of Failing Grafts Detected by Graft Surveillance after Lower Extremity Arterial Bypass

ABSTRACT

PURPOSE: We wanted to determine the incidence and characteristics of failing graft after implantation of autologous reversed vein grafts. METHOD: From Sep. 2003 to Dec. 2005, 84 leg bypasses using autologous reversed vein grafts were performed for chronic leg ischemia in 75 patients. After the operations, duplex ultrasonography (DUS) and measurement of the ankle brachial index (ABI) were performed every 3 months for the purpose of examining the graft patency. The criteria for a failing graft was a peak systolic velocity (PSV) of the stenotic lesion >300 cm/s, or a PSV distal to the occlusive lesion <40 cm/s, but with sustained patency of the vein graft. We investigated the timing of detection, the site of the causative lesion, and the clinical symptoms of the failing grafts. For the treatment of failing grafts, surgeries (vein patch, graft extension, or inflow artery reconstruction) were performed in 4 legs. The Kaplan Meier method was used for calculating the rate of graft patency. RESULT: Nine failing grafts were detected by DUS in 8 patients. The sites of causative lesions were the inflow artery (2), the proximal anastomosis (6), and the distal anastomosis (1). Seven of the 9 patients with failing grafts were asymptomatic, 1 patient had claudication and another patient suffered from resting pain of the involved leg. The assisted graft primary patency rates at 1 and 2 years after operations were 86% and 53%, respectively. CONCLUSION: Nine cases of failing grafts were detected during surveillance with duplex ultrasonography after implantation of autologous reversed vein grafts.