Effectiveness of surveillance of infrainguinal grafts

Objective: To audit the surveillance programme of infrainguinal vein graft in a tertiary vascular unit, and find out how effective it was in preventin g occlusion of grafts. Design: Retrospective study. Setting: Teaching hospital, Scotland. Subjects: 59 consecutive patients who had 61 vein grafts between 1996 and 1 998 for critical limb ischaemia. Interventions: Grafts scanned at 3-monthly intervals for at least a year, a nd clinical review. Main outcome measures: Survival with an intact limb and patency of the graf t. Results: 52 of the 59 patients (90%) were alive at the time of follow up, a nd 55 of the 61 involved limbs (90%) were intact. Median follow up was 660 days (range 180-1995). 23 stenoses were detected by the surveillance progra mme. 17 grafts were revised, all of which were patent at follow up, and 8 o ther grafts occluded requiring 6 major amputations. One-year cumulative pri mary, primary-assisted, and secondary patency, and limb salvage rates were 63%, 88%, 88%, and 90% respectively. Conclusions: Surveillance of infrainguinal grafts by duplex scanning is eff ective and has resulted in high rates of limb salvage and secondary patency in patients who presented with critical ischaemia.