FEMORODISTAL VEIN GRAFTS - THE UTILITY OF GRAFT SURVEILLANCE CRITERIA

Purpose: This retrospective review of femorodistal vein grafts was ana lyzed to determine the usefulness of various graft surveillance criter ia. Method: The surveillance schedule involved evaluations at 1 month, every 3 months the first year, and then every 6 months. Salvage inter vention or graft occlusion occurring within the next follow-up interva l defined surveillance end points. One hundred two grafts (329 surveil lance visits) had an ankle/brachial index (ABI). A duplex scanning-det ermined midgraft peak systolic flow velocity (PSPV) was available for 81 grafts (262 visits). Forty-eight grafts (137 visits) had both a PSF V and entire graft duplex scanning (EGDS) to determine stenosis greate r than 50%, whereas 40 grafts (91 visits) had simultaneous ABI and EGD S. Results: When a greater than 15% decrease in ABI denoted an abnorma l surveillance study result, a positive predictive value (PPV) of 24.3 % and negative predictive value of 94.5% were noted. Similarly, a PSPV cutoff of less than 3 5 cm/sec demonstrated values of 26.3% and 94.2% , respectively. When an EGDS of greater than 50% stenosis or a PSFV of less than 35 cm/sec were the cutoff criteria, the PPV was 36.7% and n egative predictive value 99.1%, whereas characterizing abnormal result s further with ABI (>15% down arrow) increased the PPV to 83.3%. Concl usion: The combination of an EGDS, midgraft PSFV, and ABI provides opt imal follow-up for our patients with a femorodistal vein graft.