Postoperative duplex scan surveillance of axillofemoral bypass grafts

Scott E. Musicant, Mary E. Giswold, Christine J. Olson, Gregory Landry, Lloyd M. Taylor, Richard A. Yeager, James Edwards, Gregory (Greg) Moneta

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    Abstract

    Objective: Duplex scan surveillance (DS) for axillofemoral bypass grafts (AxFBGs) has not been extensively studied. The intent of this study was twofold: 1, to characterize the flow velocities within AxFBGs; and 2, to determine whether postoperative DS is useful in assessment of future patency of AxFBGs. Methods: We identified all patients who underwent AxFBG procedures between January 1996 and January 2001 at our combined university and Veterans Affairs hospital vascular surgical service. All grafts were performed with ringed 8-mm polytetrafluoroethylene with the distal limb of the axillofemoral component anastomosed to the hood of the femoral-femoral graft. DS was every 3 months for 1 year and every 6 months thereafter. Duplex scan results were compared in primarily patent grafts with grafts that thrombosed. Graft failures from infection were excluded. Influences of ankle-brachial index, blood pressure, outflow patency, operative indication, and comorbidities on graft patency were analyzed. Results: One hundred twenty patients underwent AxFBG procedures. Twenty-eight were excluded because of infection or death before surveillance examination. Fourteen were lost to follow-up, 23 had failed grafts from occlusion, and 55 had grafts that remained patent. In the 78 patients evaluated during long-term follow-up period, the mean peak systolic velocities (PSVs) at the proximal (axillary) anastomosis during the first postoperative year ranged from 153 to 194 cm/s. Mean PSVs at the mid portion of the axillofemoral graft during the first postoperative year ranged from 100 to 125 cm/s, whereas those for the distal axillofemoral anastomosis ranged from 93 to 129 cm/s. Mean midgraft and distal anastomotic velocities obtained before thrombosis were significantly lower in the thrombosed grafts compared with the last recorded velocities at the same sites in the patent grafts (mean PSV, 84 versus 112 cm/s; P = .015; mean PSV, 89 versus 127 cm/s; P = .024, respectively). Forty-eight percent of occluded grafts had a mean midgraft PSV at last observation of less than 80 cm/s. Blood pressure correlated with midgraft velocity (r = 0.415; P <.05). With multivariate logistic regression analysis, a mean midgraft velocity less than 80 cm/s was the sole independent factor associated with graft failure (P <.01). No patients with midgraft velocities greater than 155 cm/s had occlusion. Conclusion: Flow velocity varies widely within and among AxFBGs. Patency of AxFBGs is associated with higher midgraft PSV, and thrombosis with midgraft velocities less than 80 cm/s.

    Original languageEnglish (US)
    Pages (from-to)54-61
    Number of pages8
    JournalJournal of Vascular Surgery
    Volume37
    Issue number1
    DOIs
    StatePublished - Jan 1 2003

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    Transplants
    Thrombosis
    Thigh
    Hospital Surgery Department
    Blood Pressure
    Veterans Hospitals
    Ankle Brachial Index
    Lost to Follow-Up
    Polytetrafluoroethylene
    Infection
    Blood Vessels
    Comorbidity
    Extremities
    Logistic Models
    Regression Analysis
    Observation

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Postoperative duplex scan surveillance of axillofemoral bypass grafts. / Musicant, Scott E.; Giswold, Mary E.; Olson, Christine J.; Landry, Gregory; Taylor, Lloyd M.; Yeager, Richard A.; Edwards, James; Moneta, Gregory (Greg).

    In: Journal of Vascular Surgery, Vol. 37, No. 1, 01.01.2003, p. 54-61.

    Research output: Contribution to journalArticle

    Musicant, Scott E. ; Giswold, Mary E. ; Olson, Christine J. ; Landry, Gregory ; Taylor, Lloyd M. ; Yeager, Richard A. ; Edwards, James ; Moneta, Gregory (Greg). / Postoperative duplex scan surveillance of axillofemoral bypass grafts. In: Journal of Vascular Surgery. 2003 ; Vol. 37, No. 1. pp. 54-61.
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    abstract = "Objective: Duplex scan surveillance (DS) for axillofemoral bypass grafts (AxFBGs) has not been extensively studied. The intent of this study was twofold: 1, to characterize the flow velocities within AxFBGs; and 2, to determine whether postoperative DS is useful in assessment of future patency of AxFBGs. Methods: We identified all patients who underwent AxFBG procedures between January 1996 and January 2001 at our combined university and Veterans Affairs hospital vascular surgical service. All grafts were performed with ringed 8-mm polytetrafluoroethylene with the distal limb of the axillofemoral component anastomosed to the hood of the femoral-femoral graft. DS was every 3 months for 1 year and every 6 months thereafter. Duplex scan results were compared in primarily patent grafts with grafts that thrombosed. Graft failures from infection were excluded. Influences of ankle-brachial index, blood pressure, outflow patency, operative indication, and comorbidities on graft patency were analyzed. Results: One hundred twenty patients underwent AxFBG procedures. Twenty-eight were excluded because of infection or death before surveillance examination. Fourteen were lost to follow-up, 23 had failed grafts from occlusion, and 55 had grafts that remained patent. In the 78 patients evaluated during long-term follow-up period, the mean peak systolic velocities (PSVs) at the proximal (axillary) anastomosis during the first postoperative year ranged from 153 to 194 cm/s. Mean PSVs at the mid portion of the axillofemoral graft during the first postoperative year ranged from 100 to 125 cm/s, whereas those for the distal axillofemoral anastomosis ranged from 93 to 129 cm/s. Mean midgraft and distal anastomotic velocities obtained before thrombosis were significantly lower in the thrombosed grafts compared with the last recorded velocities at the same sites in the patent grafts (mean PSV, 84 versus 112 cm/s; P = .015; mean PSV, 89 versus 127 cm/s; P = .024, respectively). Forty-eight percent of occluded grafts had a mean midgraft PSV at last observation of less than 80 cm/s. Blood pressure correlated with midgraft velocity (r = 0.415; P <.05). With multivariate logistic regression analysis, a mean midgraft velocity less than 80 cm/s was the sole independent factor associated with graft failure (P <.01). No patients with midgraft velocities greater than 155 cm/s had occlusion. Conclusion: Flow velocity varies widely within and among AxFBGs. Patency of AxFBGs is associated with higher midgraft PSV, and thrombosis with midgraft velocities less than 80 cm/s.",
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    T1 - Postoperative duplex scan surveillance of axillofemoral bypass grafts

    AU - Musicant, Scott E.

    AU - Giswold, Mary E.

    AU - Olson, Christine J.

    AU - Landry, Gregory

    AU - Taylor, Lloyd M.

    AU - Yeager, Richard A.

    AU - Edwards, James

    AU - Moneta, Gregory (Greg)

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    N2 - Objective: Duplex scan surveillance (DS) for axillofemoral bypass grafts (AxFBGs) has not been extensively studied. The intent of this study was twofold: 1, to characterize the flow velocities within AxFBGs; and 2, to determine whether postoperative DS is useful in assessment of future patency of AxFBGs. Methods: We identified all patients who underwent AxFBG procedures between January 1996 and January 2001 at our combined university and Veterans Affairs hospital vascular surgical service. All grafts were performed with ringed 8-mm polytetrafluoroethylene with the distal limb of the axillofemoral component anastomosed to the hood of the femoral-femoral graft. DS was every 3 months for 1 year and every 6 months thereafter. Duplex scan results were compared in primarily patent grafts with grafts that thrombosed. Graft failures from infection were excluded. Influences of ankle-brachial index, blood pressure, outflow patency, operative indication, and comorbidities on graft patency were analyzed. Results: One hundred twenty patients underwent AxFBG procedures. Twenty-eight were excluded because of infection or death before surveillance examination. Fourteen were lost to follow-up, 23 had failed grafts from occlusion, and 55 had grafts that remained patent. In the 78 patients evaluated during long-term follow-up period, the mean peak systolic velocities (PSVs) at the proximal (axillary) anastomosis during the first postoperative year ranged from 153 to 194 cm/s. Mean PSVs at the mid portion of the axillofemoral graft during the first postoperative year ranged from 100 to 125 cm/s, whereas those for the distal axillofemoral anastomosis ranged from 93 to 129 cm/s. Mean midgraft and distal anastomotic velocities obtained before thrombosis were significantly lower in the thrombosed grafts compared with the last recorded velocities at the same sites in the patent grafts (mean PSV, 84 versus 112 cm/s; P = .015; mean PSV, 89 versus 127 cm/s; P = .024, respectively). Forty-eight percent of occluded grafts had a mean midgraft PSV at last observation of less than 80 cm/s. Blood pressure correlated with midgraft velocity (r = 0.415; P <.05). With multivariate logistic regression analysis, a mean midgraft velocity less than 80 cm/s was the sole independent factor associated with graft failure (P <.01). No patients with midgraft velocities greater than 155 cm/s had occlusion. Conclusion: Flow velocity varies widely within and among AxFBGs. Patency of AxFBGs is associated with higher midgraft PSV, and thrombosis with midgraft velocities less than 80 cm/s.

    AB - Objective: Duplex scan surveillance (DS) for axillofemoral bypass grafts (AxFBGs) has not been extensively studied. The intent of this study was twofold: 1, to characterize the flow velocities within AxFBGs; and 2, to determine whether postoperative DS is useful in assessment of future patency of AxFBGs. Methods: We identified all patients who underwent AxFBG procedures between January 1996 and January 2001 at our combined university and Veterans Affairs hospital vascular surgical service. All grafts were performed with ringed 8-mm polytetrafluoroethylene with the distal limb of the axillofemoral component anastomosed to the hood of the femoral-femoral graft. DS was every 3 months for 1 year and every 6 months thereafter. Duplex scan results were compared in primarily patent grafts with grafts that thrombosed. Graft failures from infection were excluded. Influences of ankle-brachial index, blood pressure, outflow patency, operative indication, and comorbidities on graft patency were analyzed. Results: One hundred twenty patients underwent AxFBG procedures. Twenty-eight were excluded because of infection or death before surveillance examination. Fourteen were lost to follow-up, 23 had failed grafts from occlusion, and 55 had grafts that remained patent. In the 78 patients evaluated during long-term follow-up period, the mean peak systolic velocities (PSVs) at the proximal (axillary) anastomosis during the first postoperative year ranged from 153 to 194 cm/s. Mean PSVs at the mid portion of the axillofemoral graft during the first postoperative year ranged from 100 to 125 cm/s, whereas those for the distal axillofemoral anastomosis ranged from 93 to 129 cm/s. Mean midgraft and distal anastomotic velocities obtained before thrombosis were significantly lower in the thrombosed grafts compared with the last recorded velocities at the same sites in the patent grafts (mean PSV, 84 versus 112 cm/s; P = .015; mean PSV, 89 versus 127 cm/s; P = .024, respectively). Forty-eight percent of occluded grafts had a mean midgraft PSV at last observation of less than 80 cm/s. Blood pressure correlated with midgraft velocity (r = 0.415; P <.05). With multivariate logistic regression analysis, a mean midgraft velocity less than 80 cm/s was the sole independent factor associated with graft failure (P <.01). No patients with midgraft velocities greater than 155 cm/s had occlusion. Conclusion: Flow velocity varies widely within and among AxFBGs. Patency of AxFBGs is associated with higher midgraft PSV, and thrombosis with midgraft velocities less than 80 cm/s.

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