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Preoperative prediction of graft patency for infrapopliteal arterial bypass using pulse-generated runoff
R A Harris1, P Kumar, J Collin
1Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, U.K.
Objective:
to assess: (i) pulse-generated runoff (PGR) as a tool for preoperative prediction of graft patency; (ii) the effect of PGR use on graft patency.
Design:
retrospective analysis of continuous patient data.
Materials:
all patients undergoing bypass to the infrapopliteal vessels in the Oxford Regional Vascular Unit between 1989 and 1993.
Methods:
preoperative assessment using ankle-brachial indices, intra-arterial digital subtraction angiography and PGR. Six-monthly and then yearly clinical and duplex sonography follow-up to assess graft patency. Univariate analysis of graft patency to assess discriminatory ability of PGR for graft patency.
Results:
a biphasic signal in the artery of insertion was associated with significantly better graft patency rate at 1 month and at maximum follow-up than was a monophasic signal. A monophasic signal was associated with a 12-month patency of 25% and a mortality of 37.7%. Use of PGR did not affect graft patency significantly.
Conclusion:
PGR is a useful, non-invasive, means of preoperative patient assessment to determine the potential for maintained graft patency.