The role of simple non-invasive testing in infra-inguinal vein graft surveillance

A prospective vein graft screening programme was established in order to improve graft patency in the period 1-12 months after operation. Patient assessment consisted of ankle:brachial pressure index (ABPI) measurement before and after exercise, and Duplex scanning. Thirty-nine grafts have been followed up, with 19 stenoses detected in 18 grafts (46%) using Duplex. Of these 18 grafts, six had a serial fall in resting ABPI, median 0.14 (range 0.11-0.33), and nine had a post-exercise ABPI fall, median 0.19 (range 0.13-0.4). The remaining three had a normal ABPI but were unable to exercise. Fifteen grafts have been treated, 12 by percutaneous transluminal angioplasty (PTA), and three by surgery. One stenosis treated with PTA recurred within 3 months and was repaired with a vein patch. Since screening was implemented no grafts in the programme have occluded. This study indicates that simple ABPI measurements can be used to screen "at risk" grafts for evaluation with Duplex scanning, without jeopardising graft patency.