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Graft stenosis: justification for 1-year surveillance.
P R Taylor1, J H Wolfe, M R Tyrrell
1Vascular Unit, St. Mary's Hospital and Medical School, Paddington, London, UK.
The British Journal of Surgery
|October 1, 1990
Summary
Graft surveillance for femorodistal bypasses is valuable, primarily within the first year post-operation, as stenoses typically manifest then. Approximately 25% of these grafts develop issues, necessitating monitoring.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Femorodistal bypass grafts are crucial for limb salvage.
- Graft stenosis is a significant cause of bypass failure.
- Early detection and management of stenosis are key to long-term patency.
Purpose of the Study:
- To prospectively evaluate the incidence and timing of stenoses in femorodistal grafts.
- To assess the effectiveness of interventions for graft stenosis.
- To determine the optimal surveillance period for femorodistal bypasses.
Main Methods:
- Prospective study of 412 femorodistal grafts (femoropopliteal and femorocrural) from 1984-1988.
- Follow-up included duplex scanning and intravenous digital subtraction angiography at regular intervals.
- Analysis of stenosis incidence, timing, and outcomes of secondary and tertiary procedures.
Main Results:
- Overall stenosis incidence was 16%, with all detected within the first year.
- Forty-two hemodynamically significant stenoses were treated with secondary procedures in 30 grafts.
- Interventions like percutaneous balloon dilatation and surgical revision showed variable patency rates.
Conclusions:
- Graft surveillance for femorodistal bypasses is beneficial, particularly during the first year post-operation.
- Approximately one-quarter of femorodistal grafts develop graft-related stenoses.
- Timely intervention for significant stenoses can improve graft patency.