Hemodynamic parameters of failing infrainguinal bypass grafts

To assess the relationship of duplex ultrasound hemodynamic parameters in stenotic vein grafts with events such as graft thrombosis or surgical revisions.

We studied 35 patent infrainguinal bypass grafts that were observed by means of color duplex graft mapping using a surveillance protocol.

During the 11.2 month mean follow-up interval, 10 grafts developed complications. Two stenotic grafts (1 already revised) thrombosed spontaneously, and arteriography was obtained on the basis of either clinical indications or a decreased ankle/brachial index of greater than 0.15 on 9 bypasses, leading to 12 procedures (multiple procedures on 2 grafts). The 14 duplex examinations preceding an event showed these bypasses had increased focal peak systolic velocities that ranged from 250 to 600 cm/s and velocity ratios that ranged from 3.4 to 25.0 at the stenotic segment of the graft, anastomosis, or outflow artery. None of the grafts with a stenotic peak systolic velocity less than 250 cm/s or a velocity ratio less than 3.4 thrombosed spontaneously or required revision.

We conclude that stenotic vein grafts with a focal peak systolic velocity of at least 250 cm/s or a velocity ratio of at least 3.4 are at increased risk for thrombosis or need for revision. Asymptomatic stenotic vein grafts with focal peak systolic velocities and ratios less than the above values may be safely observed without immediate risk for thrombosis.