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[Quality control in peripheral vascular surgery]

M Enzler1, M Ruoss, M Heinzelmann

  • 1Departement Chirurgie, Universitätsspital Zürich.

Swiss Surgery = Schweizer Chirurgie = Chirurgie Suisse = Chirurgia Svizzera
|January 1, 1995
PubMed
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Quality control in infrainguinal bypass surgery, including intraoperative checks and postoperative surveillance, improves graft patency rates. Early detection and repair of technical errors and myo-intimal hyperplasia are crucial for long-term success.

Area of Science:

  • Vascular Surgery
  • Graft Patency
  • Quality Control

Context:

  • Infrainguinal bypass surgery is prone to graft occlusion, particularly within the first postoperative year.
  • Technical errors and myo-intimal hyperplasia are primary causes of early and late graft failure, respectively.
  • Effective quality control and surveillance are essential to maintain graft patency.

Purpose:

  • To review and discuss quality control indications and modalities in infrainguinal bypass surgery.
  • To present a practical concept and armamentarium for quality control.
  • To emphasize the importance of identifying failing grafts and avoiding failure through surveillance.

Summary:

  • A routine surveillance program involving intraoperative completion angiography, postoperative ankle-brachial index (ABI) measurements, and duplex sonography was implemented.

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  • Data were stored in an electronic database for automated calculation and rating of ABI and duplex sonography indices.
  • Secondary patency rates after 18 months were 86% for suprageniculate femoro-popliteal, 84% for infrageniculate, and 65% for crural bypass grafts.

    • Impact:

    • Intraoperative completion control can detect and repair technical errors, significantly improving early graft patency.
    • Timely detection and dilation of stenoses caused by myo-intimal hyperplasia preserve long-term graft function.
    • Routine surveillance programs are vital for optimizing outcomes in infrainguinal bypass surgery, outperforming grafts managed with thrombectomy or thrombolysis.