Duplex ultrasound surveillance of infrainguinal bypass grafts: auditing the process

The effectiveness of an infrainguinal bypass graft surveillance programme using duplex scanning was assessed over a 2-year period. Of 220 infrainguinal bypass grafts (123 vein and 97 PTFE grafts; 114 to the above knee level, 94 below knee and 12 distal to popliteal artery) in 203 patients, 208 (94.5%) were available for follow-up surveillance. The protocol called for duplex scans at 6 weeks, 3, 6, 9 and 12 months. Fifty-seven grafts (27%) were found to have a V1/V2 ratio equal to or greater than 1.5 and in this group 25 grafts occluded. The median time between primary operation and positive duplex finding was 4 months. Thirty-nine grafts failed during follow-up (at time of analysis median follow-up was 12 months [range 2-83 months]). There were 18 interventions resulting from surveillance-detected stenoses. The median time between positive duplex finding and further investigation was 2 months. Further, there were significant differences in the site of abnormal findings between ePTFE and vein grafts. The value of a surveillance programme may be reduced if there are low rates of intervention and/or excessive delays in intervention following the demonstration of graft-related stenoses. Surveillance programmes and subsequent interventions need to be audited.