Postoperative surveillance. An effective means of detecting correctable lesions that threaten graft patency

Thirteen patients with recurrent ischemia following previous vascular surgery and 13 patients with primary ischemia were prospectively evaluated with segmental Doppler pressure indices and selective intravenous digital subtraction angiography. Ten patients with recurrent postoperative ischemia had thrombosed bypasses, and three had stenosed but patent grafts. Eight (62%) of the 13 patients had successful vascular repair, the rest had amputations. All patients with previous vascular surgery and those with primary bypasses were prospectively followed up with segmental Doppler pressure indices. Falling segmental Doppler pressure index values occurred in eight patients and in six patients prior to onset of recurrent ischemia. Intravenous digital subtraction angiography demonstrated correctable stenotic lesions in the six asymptomatic patients and untreatable host vessel occlusion in two symptomatic patients. Corrective surgery successfully preserved patency of all stenosed grafts. In summary, postoperative surveillance can detect occlusive changes before recurrent symptoms occur. Repair of stenosed grafts is more successful than repair of occluded grafts.