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Insonation and impedance analysis in graft surveillance
K R Woodburn1, A Murtagh, P Breslin
1Unit for Peripheral Vascular Surgery, Royal Infirmary, Glasgow, UK.
The British Journal of Surgery
|September 1, 1995
Summary
Computer-assisted impedance analysis and graft insonation effectively screen infrainguinal bypass grafts for issues. This combined approach identifies grafts at risk with high sensitivity, reducing unnecessary arteriograms.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Infrainguinal bypass grafts are crucial for limb salvage.
- Effective graft surveillance is essential to prevent graft failure.
- Early detection of 'at risk' grafts can improve outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a surveillance program for infrainguinal bypass grafts.
- To assess the sensitivity of color duplex scanning, graft insonation, and impedance analysis in identifying grafts at risk.
- To determine the optimal combination of techniques for early graft issue detection.
Main Methods:
- A 1-year surveillance program involving 54 patients with 54 infrainguinal bypass grafts (30 vein, 24 synthetic).
- Utilized color duplex scanning, direct graft insonation, and computer-assisted impedance analysis.
- Arteriography was performed for grafts with positive duplex scans, high insonation frequencies, or impedance values > 0.50.
Main Results:
- 21 out of 54 grafts were confirmed to be 'at risk'.
- Impedance value > 0.55 had 86% sensitivity; combined with graft insonation, sensitivity rose to 95%.
- Color duplex scanning missed abnormalities in 11 grafts later identified by arteriography.
Conclusions:
- Impedance measurement and graft insonation are sensitive screening techniques for infrainguinal grafts.
- Combining impedance measurement and graft insonation significantly enhances the detection of 'at risk' grafts.
- These methods can identify 'at risk' vein grafts and minimize unnecessary arteriograms.