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Published on: April 3, 2015
Effectiveness of surveillance of infrainguinal grafts
1Peripheral Vascular Unit, Royal Infirmary, Glasgow, Scotland, United Kingdom. teonb@hotmail.com
Insights
Regular surveillance of infrainguinal vein grafts using duplex scanning effectively prevents graft occlusion. This approach leads to high rates of limb salvage and graft patency in critical limb ischemia patients.
Area of Science:
- Vascular Surgery
- Graft Surveillance
- Critical Limb Ischemia
Background:
- Infrainguinal vein grafts are crucial for treating critical limb ischemia.
- Graft occlusion remains a significant complication, leading to limb loss.
- Effective surveillance is needed to maintain graft patency and limb viability.
Purpose of the Study:
- To audit the surveillance program for infrainguinal vein grafts.
- To evaluate the program's effectiveness in preventing graft occlusion.
- To determine limb salvage and graft patency rates.
Main Methods:
- Retrospective study conducted in a tertiary vascular unit.
- Reviewed 61 infrainguinal vein grafts in 59 patients (1996-1998).
- Grafts underwent surveillance via duplex scanning and clinical review at 3-month intervals for at least one year.
Main Results:
- 90% of patients were alive and 90% of limbs remained intact at follow-up.
- Surveillance detected 23 graft stenoses, leading to 17 revisions with maintained patency.
- One-year cumulative primary patency was 63%, with limb salvage at 90%.
Conclusions:
- Duplex scanning surveillance of infrainguinal vein grafts is effective.
- The program significantly contributes to high limb salvage rates.
- High secondary patency rates were achieved in patients with critical limb ischemia.
Objective:
To audit the surveillance programme of infrainguinal vein graft in a tertiary vascular unit, and find out how effective it was in preventing occlusion of grafts.
Design:
Retrospective study.
Setting:
Teaching hospital, Scotland.
Subjects:
59 consecutive patients who had 61 vein grafts between 1996 and 1998 for critical limb ischaemia.
Interventions:
Grafts scanned at 3-monthly intervals for at least a year, and clinical review.
Main Outcome Measures:
Survival with an intact limb and patency of the graft.
Results:
52 of the 59 patients (90%) were alive at the time of follow up, and 55 of the 61 involved limbs (90%) were intact. Median follow up was 660 days (range 180-1995). 23 stenoses were detected by the surveillance programme. 17 grafts were revised, all of which were patent at follow up, and 8 other grafts occluded requiring 6 major amputations. One-year cumulative primary, primary-assisted, and secondary patency, and limb salvage rates were 63%, 88%, 88%, and 90% respectively.
Conclusions:
Surveillance of infrainguinal grafts by duplex scanning is effective and has resulted in high rates of limb salvage and secondary patency in patients who presented with critical ischaemia.
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