INTENSIVE SURVEILLANCE OF FEMOROPOPLITEAL-TIBIAL AUTOGENOUS VEIN BYPASSES IMPROVES LONG-TERM GRAFT PATENCY AND LIMB SALVAGE

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.