INTRAOPERATIVE COLOR DUPLEX SCANNING FOR INFRAINGUINAL VEIN GRAFTS

We compared the findings of intraoperative color duplex scanning and c ompletion arteriography in patients undergoing infrainguinal vein bypa sses to identify hemodynamic abnormalities that could result in a pred isposition to early or late graft failure. We reviewed the records of 72 patients who underwent 81 vein bypass graft procedures. Three intra operative diagnostic methods were used. In 28 procedures (group I) bot h color duplex and completion arteriography were used, in 21 procedure s (group II) only color duplex was used, and in 26 procedures (group I II) only completion arteriography was used. Grafts were followed using a duplex surveillance protocol for a mean interval of 16.1 months. Ni ne grafts in group I showed an abnormality on the duplex scan but not on the completion arteriogram. Seven grafts had a peak systolic veloci ty (PSV) greater than 200 cm/sec and two had a PSV less than 45 cm/sec . These findings led to six immediate repairs, one early revision, and two late revisions. Arteriography demonstrated additional defects in two procedures but repairs were not performed. In group II duplex scan s showed an abnormality in eight procedures (seven grafts with PSV 200 to 250 cm/sec and one graft with a retained valve) resulting in three immediate repairs and five late revisions. In the remaining 13 proced ures in group II, duplex scans were normal and no revisions were requi red during follow-up. In group III defects were detected by arteriogra phy in four procedures (>50% stenosis in three grafts and one arterial spasm) leading to three immediate repairs. In the remaining 22 studie s arteriograms were interpreted as normal; however, seven of these gra fts required late revisions. Our data suggest that grafts that appear normal on intraoperative duplex scans are not likely to develop a sten osis requiring revision. Intraoperative duplex ultrasound may be super ior to completion arteriography.