Do normal early color-flow duplex surveillance examination results of infrainguinal vein grafts preclude the need for late graft revision?

Marc A. Passman, Gregory (Greg) Moneta, Mark R. Nehler, Lloyd M. Taylor, James Edwards, Richard A. Yeager, Donald McConnell, John M. Porter

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: Optimal duration of postoperative duplexsurveillance of infrainguinal vein grafts is not known. Previous reports have suggested nearly all vein graft stenoses are present within the first postoperative year, and normal duplex examination results during this time eliminate the need for ongoing graft surveillance. To determine whether surveillance may be safely discontinued in patients with normal early postoperative surveillance studies, we reviewed the color-flow surveillance examinations in our patients who underwent infrainguinal reverse vein graft revisions during a 4 1/2 year period. Methods: Clinical and vascular laboratory records were reviewed of all patients who underwent infrainguinal reverse vein bypass grafting followed by subsequent graft revision for a duplex scanning-detected abnormality at our institution between January 1990 and July 1994. Results: Of 447 infrainguinal reverse vein bypasses performed, 36 (8.1%) underwent surgical revision as a result of an abnormal finding during routine duplex surveillance. The initial postoperative duplex examination was obtained within 2 weeks of graft implantation in 23 (64%) patients, between 2 weeks and 3 months in 10 (28%) patients, and between 3 and 6 months in three (8%) patients. Duplex abnormalities prompting revision included 11 (31%) grafts with a mid-graft peak systolic velocity (PSV) ≤45 cm/sec, 23 (64%) grafts with a focal PSV ≥200 cm/sec, one graft with a PSV ≥150 cm/sec but 1 year in five (14%) patients. In only 25% of cases were mid-graft PSVs ≤45 cm/sec or focal velocities ≥200 cm/sec identified on the initial examination; 75% were found during subsequent surveillance. Conclusions: Although most reverse vein graft abnormalities detected by duplex surveillance and prompting graft revision appear within the first postoperative year, many are not detected on the initial examination. In our recent experience 31% of duplex abnormalities leading to vein graft revision were first detected more than 6 months after operation. Discontinuation of graft surveillance based on normal early findings will result in thrombosis of some vein grafts that may otherwise be salvaged. (J VASC SURG 1995;22:476-84.).

Original languageEnglish (US)
Pages (from-to)476-484
Number of pages9
JournalJournal of Vascular Surgery
Volume22
Issue number4
DOIs
StatePublished - 1995
Externally publishedYes

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Veins
Color
Transplants
Reoperation
Blood Vessels
Pathologic Constriction
Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Do normal early color-flow duplex surveillance examination results of infrainguinal vein grafts preclude the need for late graft revision? / Passman, Marc A.; Moneta, Gregory (Greg); Nehler, Mark R.; Taylor, Lloyd M.; Edwards, James; Yeager, Richard A.; McConnell, Donald; Porter, John M.

In: Journal of Vascular Surgery, Vol. 22, No. 4, 1995, p. 476-484.

Research output: Contribution to journalArticle

Passman, Marc A. ; Moneta, Gregory (Greg) ; Nehler, Mark R. ; Taylor, Lloyd M. ; Edwards, James ; Yeager, Richard A. ; McConnell, Donald ; Porter, John M. / Do normal early color-flow duplex surveillance examination results of infrainguinal vein grafts preclude the need for late graft revision?. In: Journal of Vascular Surgery. 1995 ; Vol. 22, No. 4. pp. 476-484.
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title = "Do normal early color-flow duplex surveillance examination results of infrainguinal vein grafts preclude the need for late graft revision?",
abstract = "Purpose: Optimal duration of postoperative duplexsurveillance of infrainguinal vein grafts is not known. Previous reports have suggested nearly all vein graft stenoses are present within the first postoperative year, and normal duplex examination results during this time eliminate the need for ongoing graft surveillance. To determine whether surveillance may be safely discontinued in patients with normal early postoperative surveillance studies, we reviewed the color-flow surveillance examinations in our patients who underwent infrainguinal reverse vein graft revisions during a 4 1/2 year period. Methods: Clinical and vascular laboratory records were reviewed of all patients who underwent infrainguinal reverse vein bypass grafting followed by subsequent graft revision for a duplex scanning-detected abnormality at our institution between January 1990 and July 1994. Results: Of 447 infrainguinal reverse vein bypasses performed, 36 (8.1{\%}) underwent surgical revision as a result of an abnormal finding during routine duplex surveillance. The initial postoperative duplex examination was obtained within 2 weeks of graft implantation in 23 (64{\%}) patients, between 2 weeks and 3 months in 10 (28{\%}) patients, and between 3 and 6 months in three (8{\%}) patients. Duplex abnormalities prompting revision included 11 (31{\%}) grafts with a mid-graft peak systolic velocity (PSV) ≤45 cm/sec, 23 (64{\%}) grafts with a focal PSV ≥200 cm/sec, one graft with a PSV ≥150 cm/sec but 1 year in five (14{\%}) patients. In only 25{\%} of cases were mid-graft PSVs ≤45 cm/sec or focal velocities ≥200 cm/sec identified on the initial examination; 75{\%} were found during subsequent surveillance. Conclusions: Although most reverse vein graft abnormalities detected by duplex surveillance and prompting graft revision appear within the first postoperative year, many are not detected on the initial examination. In our recent experience 31{\%} of duplex abnormalities leading to vein graft revision were first detected more than 6 months after operation. Discontinuation of graft surveillance based on normal early findings will result in thrombosis of some vein grafts that may otherwise be salvaged. (J VASC SURG 1995;22:476-84.).",
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T1 - Do normal early color-flow duplex surveillance examination results of infrainguinal vein grafts preclude the need for late graft revision?

AU - Passman, Marc A.

AU - Moneta, Gregory (Greg)

AU - Nehler, Mark R.

AU - Taylor, Lloyd M.

AU - Edwards, James

AU - Yeager, Richard A.

AU - McConnell, Donald

AU - Porter, John M.

PY - 1995

Y1 - 1995

N2 - Purpose: Optimal duration of postoperative duplexsurveillance of infrainguinal vein grafts is not known. Previous reports have suggested nearly all vein graft stenoses are present within the first postoperative year, and normal duplex examination results during this time eliminate the need for ongoing graft surveillance. To determine whether surveillance may be safely discontinued in patients with normal early postoperative surveillance studies, we reviewed the color-flow surveillance examinations in our patients who underwent infrainguinal reverse vein graft revisions during a 4 1/2 year period. Methods: Clinical and vascular laboratory records were reviewed of all patients who underwent infrainguinal reverse vein bypass grafting followed by subsequent graft revision for a duplex scanning-detected abnormality at our institution between January 1990 and July 1994. Results: Of 447 infrainguinal reverse vein bypasses performed, 36 (8.1%) underwent surgical revision as a result of an abnormal finding during routine duplex surveillance. The initial postoperative duplex examination was obtained within 2 weeks of graft implantation in 23 (64%) patients, between 2 weeks and 3 months in 10 (28%) patients, and between 3 and 6 months in three (8%) patients. Duplex abnormalities prompting revision included 11 (31%) grafts with a mid-graft peak systolic velocity (PSV) ≤45 cm/sec, 23 (64%) grafts with a focal PSV ≥200 cm/sec, one graft with a PSV ≥150 cm/sec but 1 year in five (14%) patients. In only 25% of cases were mid-graft PSVs ≤45 cm/sec or focal velocities ≥200 cm/sec identified on the initial examination; 75% were found during subsequent surveillance. Conclusions: Although most reverse vein graft abnormalities detected by duplex surveillance and prompting graft revision appear within the first postoperative year, many are not detected on the initial examination. In our recent experience 31% of duplex abnormalities leading to vein graft revision were first detected more than 6 months after operation. Discontinuation of graft surveillance based on normal early findings will result in thrombosis of some vein grafts that may otherwise be salvaged. (J VASC SURG 1995;22:476-84.).

AB - Purpose: Optimal duration of postoperative duplexsurveillance of infrainguinal vein grafts is not known. Previous reports have suggested nearly all vein graft stenoses are present within the first postoperative year, and normal duplex examination results during this time eliminate the need for ongoing graft surveillance. To determine whether surveillance may be safely discontinued in patients with normal early postoperative surveillance studies, we reviewed the color-flow surveillance examinations in our patients who underwent infrainguinal reverse vein graft revisions during a 4 1/2 year period. Methods: Clinical and vascular laboratory records were reviewed of all patients who underwent infrainguinal reverse vein bypass grafting followed by subsequent graft revision for a duplex scanning-detected abnormality at our institution between January 1990 and July 1994. Results: Of 447 infrainguinal reverse vein bypasses performed, 36 (8.1%) underwent surgical revision as a result of an abnormal finding during routine duplex surveillance. The initial postoperative duplex examination was obtained within 2 weeks of graft implantation in 23 (64%) patients, between 2 weeks and 3 months in 10 (28%) patients, and between 3 and 6 months in three (8%) patients. Duplex abnormalities prompting revision included 11 (31%) grafts with a mid-graft peak systolic velocity (PSV) ≤45 cm/sec, 23 (64%) grafts with a focal PSV ≥200 cm/sec, one graft with a PSV ≥150 cm/sec but 1 year in five (14%) patients. In only 25% of cases were mid-graft PSVs ≤45 cm/sec or focal velocities ≥200 cm/sec identified on the initial examination; 75% were found during subsequent surveillance. Conclusions: Although most reverse vein graft abnormalities detected by duplex surveillance and prompting graft revision appear within the first postoperative year, many are not detected on the initial examination. In our recent experience 31% of duplex abnormalities leading to vein graft revision were first detected more than 6 months after operation. Discontinuation of graft surveillance based on normal early findings will result in thrombosis of some vein grafts that may otherwise be salvaged. (J VASC SURG 1995;22:476-84.).

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