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Pre-operative hand-held Doppler run-off score can be used to stratify risk prior to infra-inguinal bypass surgery
A H R Stewart1, A Lucas, F C T Smith
1Vascular Studies Unit, Bristol Royal Infirmary, Bristol, UK.
Insights
Hand-held Doppler assessment of calf vessel run-off predicts graft patency and patient survival after infra-inguinal bypass surgery. Higher Doppler scores correlate with improved graft success and reduced mortality.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Clinical Outcomes Research
Background:
- Infra-inguinal bypass grafting is a critical procedure for limb salvage.
- Assessing distal perfusion preoperatively is essential for predicting surgical success.
- Hand-held Doppler offers a non-invasive method for evaluating calf vessel run-off.
Purpose of the Study:
- To determine the relationship between calf vessel run-off, assessed by hand-held Doppler, and outcomes following infra-inguinal bypass surgery.
- To evaluate the predictive value of Doppler waveform characteristics for graft patency and patient survival.
Main Methods:
- Prospective cohort study of 258 patients undergoing infra-inguinal bypass grafts.
- Preoperative assessment of ankle Doppler waveform characteristics (anterior tibial, posterior tibial, dorsalis pedis arteries) to calculate a total Doppler run-off score (0-6).
- Postoperative graft surveillance using duplex ultrasound and analysis of graft and patient survival via Cox regression.
Main Results:
- Overall primary assisted graft patency at one year was 80%.
- A significant positive correlation was observed between increasing Doppler scores (0-6) and primary assisted graft patency (50% to 100%, p = 0.0002).
- A significant inverse correlation was found between increasing Doppler scores and patient mortality (50% to 5%, p = 0.0003).
Conclusions:
- Preoperative hand-held Doppler assessment of calf vessel run-off is a valuable tool in infra-inguinal bypass surgery.
- Higher Doppler scores are associated with improved graft patency and enhanced patient survival.
- This non-invasive technique can aid in patient selection and risk stratification for infra-inguinal revascularization procedures.
Objectives:
to investigate the relationship between calf vessel run-off assessed by hand-held Doppler, graft patency and patient survival following infra-inguinal graft surgery.
Design:
prospective cohort study of 258 consecutive patients undergoing infra-inguinal bypass grafts in one centre between 1995-99.
Materials And Methods:
ankle Doppler auditory waveform characteristics were documented for patients considered for infra-inguinal bypass grafting. Doppler signals from the anterior tibial, posterior tibial and dorsalis pedis arteries were scored triphasic/biphasic (2), monophasic (1) or absent (0). A total Doppler run off score (0-6) was calculated. Following surgery graft surveillance was undertaken using duplex ultrasound at 6, 12, 26 and 52 weeks. Graft and patient survival were analysed using Cox regression analysis.
Results:
overall primary assisted graft patency at one year was 80%. With an increasing Doppler score from 0 to 6, primary assisted graft patency steadily rose from 50% to 100% (p = 0.0002), accompanied by a steady fall in patient mortality from 50% to 5% (p = 0.0003).