T. Bergamini et al., INTENSIVE SURVEILLANCE OF FEMOROPOPLITEAL-TIBIAL AUTOGENOUS VEIN BYPASSES IMPROVES LONG-TERM GRAFT PATENCY AND LIMB SALVAGE, Annals of surgery, 221(5), 1995, pp. 507-516
Objective The authors determined the impact of an intensive surveillan
ce program of autogenous vein bypasses on patency and limb salvage. Su
mmary Background Data Surveillance protocols of vein bypasses can iden
tify graft-threatening lesions to permit elective revisions before thr
ombosis. The authors compared follow-up based on clinically indicated
procedures with intensive surveillance. Methods From 1985 to 1994, 615
autogenous Vein bypasses (454 in situ, 161 reversed/composite) to pop
liteal (n = 169) and tibial (n = 446) arteries were performed for crit
ical limb ischemia(n = 507), claudication (n = 88), and popliteal aneu
rysm (n = 20). Intensive surveillance of autogenous vein bypasses cons
isted of ankle brachial index and duplex scan with graft velocities me
asured at 1 month, 3 months, 6 months, and every 6 months subsequently
. After surgery 317 bypasses had intensive surveillance, 222 bypasses
were clinically indicated for follow-up, and 76 bypasses were excluded
because follow-up or patency was less than 31 days. Results Primary p
atency at 5 years was similar for bypasses treated by intensive survei
llance (56%) and those treated with clinically indicated procedures (6
7%). Secondary patency and limb salvage at 5 years was significantly i
mproved (p < 0.02) for bypasses followed by intensive surveillance (80
% and 94%) compared with clinically indicated procedures (67% and 73%)
. Revision of patent bypasses was higher (p < 0.000001) for bypasses t
reated by intensive surveillance (61 of 70, 87%) compared with those t
reated with clinically indicated procedures (9 of 34, 26%). Secondary
patency at 2 years was significantly higher (p < 0.02) for revision of
patent bypasses (79%) compared with thrombosed bypasses (55%).Conclus
ions Long-term autogenous vein bypass patency and limb salvage is sign
ificantly improved by intensive surveillance, permitting identificatio
n and correction of graft threatening lesions before thrombosis.