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The "ad hoc" estimation of outflow does not predict patency of infrainguinal reconstructions
R Takolander1, W Fischer-Colbrie, T Jogestrand
1Dept. Surgery, Karolinska Hospital, Stockholm, Sweden.
Insights
The adhoc estimation score does not predict graft patency in infrainguinal bypasses. This study found no correlation between the SVS score and long-term success of femoropopliteal or distal bypasses.
Area of Science:
- Vascular Surgery
- Graft Patency Assessment
- Infrainguinal Bypass
Background:
- Assessing outflow quality is crucial for infrainguinal bypass graft patency.
- The adhoc estimation (SVS score) is a method used to evaluate outflow.
- Predicting graft success is vital for patient outcomes.
Purpose of the Study:
- To evaluate the clinical implication of the adhoc estimation (SVS score) of outflow.
- To determine if the SVS score predicts patency in infrainguinal in situ femoropopliteal or distal bypasses.
Main Methods:
- Prospective study of 53 infrainguinal bypasses.
- Duplex scanning follow-up at 1, 3, 6, and 12 months post-surgery.
- Analysis of adhoc scores (1-10) in relation to graft patency.
Main Results:
- 68% of bypasses remained patent at 1 year.
- Adhoc scores did not significantly correlate with early occlusions or 1-year patency.
- Patency rates were similar between diabetics (80%) and non-diabetics (64%).
Conclusions:
- The adhoc estimation of outflow from angiography is not a valuable predictor of graft patency.
- Current methods for outflow assessment may not reliably predict infrainguinal bypass success.
- Further research may be needed to identify reliable predictors of graft patency.
Objectives:
This prospective study was performed to evaluate the clinical implication of the adhoc estimation (also called SVS score) of outflow on patency of infrainguinal in situ femoropopliteal or -distal bypasses.
Methods:
The bypasses were followed with Duplex scanning at 1, 3, 6, and 12 months after surgery. Fifty-three bypasses were recruited for the study, 20 of which were performed in 17 diabetics. In 47% the adhoc scoring was < or = 4.5 and in 53% it was between 5 and 10 (1 corresponds to an excellent outflow and 10 to a blind segment).
Results:
Within the first 30 days eight occlusions occurred, all of which were surgically corrected. The adhoc score for these bypasses was 4.2 vs. 4.9 (NS) for those who did not occlude. During follow-up, revisions were performed in 21 cases (40%) with 30 interventions. At the end of 1 year, 68% of the bypasses were patent (80% among diabetics and 64% among non-diabetics, NS). Patency at 1 year was not influenced by the adhoc classification.
Conclusion:
The estimation of outflow from angiography seems to be of no value in predicting graft patency in infrainguinal grafting.