Technical defects as a cause of early graft failure after femorodistal bypass

Technical defects threaten the early patency of infrainguinal bypass grafts. We reviewed 849 cases of femorodistal bypass to determine the incidence of technical graft failure, as well as other causes of early graft occlusion. The efficacy of adjunctive intraoperative arteriography was assessed. Early graft failure occurred in 62 (7.3%) cases and was due to technical defects in nine (14.5%) cases. Embolization caused early failure in six (9.7%) cases, coagulation disorders caused occlusion in ten (16.1%) cases, and failure was due to inadequate runoff in seven (11.3%) cases. No identifiable cause of graft thrombosis was found in 30 (48%) cases, but thrombectomy and empiric anticoagulation therapy salvaged 25 of these grafts. Intraoperative arteriography was very specific (98%) and moderately sensitive (76%) for the detection of technical defects in this series. Technical defects appear not to be the most common cause of early infrainguinal bypass graft failure and were found in only 1% of all cases reviewed. Critical attention must be given to other causes, such as emboli, and particularly to disorders of the host coagulation system that may threaten the success of the procedure.