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Early vein bypass thrombectomy is associated with an increased risk of graft related stenoses
T G Nielsen1, L P Jensen, T V Schroeder
1Department of Vascular Surgery, Rigshospitalet, University Hospital, Copenhagen, Denmark.
Objectives:
To assess the risk of graft stenoses following early thrombectomy of peripheral vein bypasses.
Design:
Prospective study of 371 vein bypasses performed at the Vascular Service, Rigshospitalet, Copenhagen from January 1991 through December 1992.
Materials And Methods:
Thirty-six vein bypasses reopened by thrombectomy within 30 days postoperatively (group I) and 335 bypasses not subjected to early thrombectomy (group II) were studied by ultrasound duplex scanning 3, 6, 9, 12, 18, 24, 36 and 48 months postoperatively. A localised increase in the peak systolic velocity of 250% or more was considered an indicator for significant stenosis.
Results:
In the perioperative period nine (2%) patients died, 30 (8%) bypasses occluded and 14 (4%) patients were lost to follow-up. Among the 318 patients remaining at risk at 1 month graft stenoses were identified in 39% (9/23) in group I compared to 17% (51/295) in group II, p = 0.03. Late bypass revisions were required in 35% (8/23) in group I as opposed to 9% (28/295) in group II, p = 0.004. Despite this high number of revisional procedures the 12-months secondary bypass patency was lower in recanalised grafts (38% vs. 82%, p < 0.00001).
Conclusion:
Early vein bypass thrombectomy is associated with a two-fold increased risk of graft related stenoses and a reduced secondary bypass patency.