Vein graft lesions: time of onset and rate of progression

The objectives of this study were to determine the time of onset, location, severity, rate of progression, and subsequent fate of infrainguinal vein graft lesions.

Sixty-one infrainguinal vein grafts were studied serially with duplex ultrasonography to document the location and severity of each lesion. Grafts were studied at 1, 2, 3, 4, 6, 9, 12, and 18 months and then annually.

The cumulative secondary graft patency rate at 3 years (life-table analysis) was 93.2%. A total of 158 lesions were detected in 55 of the 61 grafts studied. The degree of diameter reduction at the time of initial detection was as follows: 1% to 19% (29.6%), 20% to 49% (51.0%), 50% to 75% (17.3%), and greater than 75% (3.1%). Forty-eight percent were detected at the first examination, 59.2% within 2 months, and 85.7% within 6 months. Progression was detected in 31.2% of the lesions by 6 and in 39.1% of the lesions by 18 months (life-table analysis). Thrombosis, in the absence of significant changes in ankle-brachial index (> or = 0.15) or return of symptoms, was not observed in grafts that had lesions with less than 75% diameter reduction.

The data support the performance of a duplex scan either during surgery or before discharge from the hospital in addition to frequent surveillance for the first 6 months. Frequent surveillance is appropriate for lesions with less than 75% diameter reduction as long as they remain asymptomatic and without a significant reduction in the ankle-brachial index.