EARLY POSTOPERATIVE DIGITAL SUBTRACTION A NGIOGRAPHY AFTER INFRAINGUINAL BYPASS RECONSTRUCTIONS

Bypass occlusions in infrainguinal arterial reconstructions occur in u p to 20% within the first postoperative month and are caused by techni cal defects in most cases. In a prospective study to evaluate the impo rtance of imaging techniques in infrainguinal bypass grafting 81 of 10 3 bypasses were examined by intraarterial DSA 10 days postoperatively. The findings of early postoperative DSA were compared with the result s of intraoperative angioscopy and completion angiography. In 11 cases (13,6%) there were additional pathological findings. In 6 patients st enoses mere localized at the proximal anastomosis, which could not be visualized intraoperatively due to technical reasons. In 2 more patien ts postoperative DSA revealed an occlusion of the distal segment of th e recipient artery with a retrograde blood flow in the proximal segmen t. Further pathological findings were one perianastomotic stenosis cau sed by a thrombus at a venous valve site and one arteriovenous fistula in an in-situ-bypass. In one more patient angiography showed a stenos is in the outflow tract. The duplex-derived PSV, however, was normal a nd no revision was made. At present, examination of the proximal anast omosis is possible by intraoperative DSA, but initially unrecognized a nd secondary bypass defects can only be identified by early postoperat ive DSA in asymptomatic patients. A final scrutiny of the arterial rec onstruction can be achieved by postoperative DSA without any recogniza ble morbidity before subsequent bypass function is monitored by non in vasive methods like duplex sonography.