Femorodistal graft failure: is our follow-up adequate?

The central problem of femoral distal by-pass is the high incidence of graft failure, particularly in the first year with a steady fall-off in subsequent years. The nature of graft occlusion is related to immediate failure, usually technical, early failure due to myo-intimal hyperplasia and late failure due to progression of atheroma. Prevention lies in improved operative technique and early diagnosis during the post-operative follow-up period for which intravenous digital subtraction angiography may be important. Graft occlusion usually results in amputation, however, graft stenosis may be corrected by operation or by percutaneous trans-luminal angioplasty. Thus surveillance plus interventional radiology may lead to impaired graft patency.