VEIN GRAFT STENOSIS - INCIDENCE AND INTERVENTION

Objectives: The incidence of vein graft stenosis ranges from 5%-45%. R eported rates appear to be increasing as technological advances make d etection easier. The aim of this study was to review our experiences w ith regard to the incidence of stenosis in infrainguinal bypass grafts and the outcome of intervention for salvage obtaining grafts. Design: Retrospective review of graft surveillance records. Setting Vascular Studies Unit, Bristol Royal Infirmary. Methods: A Duplex-based graft s urveillance (GS) programme was used from January 1989 to June 1994 to study 275 primary graft procedures in 250 patients with lower limb isc haemia. Patients were scanned at I week, 6 weeks and 3, 6, 9 and 22 mo nths postoperatively. Results: One year cumulative limb salvage, patie nt survival and primary, primary assisted and secondary patencies were 92%, 83%, 67%, 77% and 84% respectively. Duplex scanning detected 85 vein graft stenoses in 59 patients: an incidence of 21.5%. In addition , 64 potentially graft-threatening inflow (14) and outflow (50) proble ms were detected in the native vessels of 52 patients from clamp damag e or progression of disease (POD). Of the 85 graft stenoses, 40 were t reated by balloon angioplasty (PTA) and 20 by surgical intervention an d 1 patient's symptoms were treated by chemical sympathectomy. Twenty- four patients were not actively treated. Of the 64 grafts affected by POD, 20 were treated by PTA, 15 by surgery, one with anti-coagulation and 28 had no treatment. Comparing patients with non-treated and treat ed lesions, the respective 12 month cumulative patencies for patients with graft stenoses were 75% and 87.5% as against 86% and 83% for pati ents with POD (log rank test : p > 0.1). Conclusions: These results up hold the perceived benefits of a GS programme, although the evidence f rom the non-treated cases in this series reinforces a need for a large , prospective, randomised trial to confirm the case for GS.