Early results of infragenicular revascularization based solely on duplex arteriography

Purpose: Recent reports have both advocated and questioned the utility of d uplex arteriography (DA) as the sole preoperative imaging modality for plan ning infragenicular revascularization. This study compares the outcome of p atients with critical limb ischemia who underwent infragenicular vein graft s on the basis of DA alone versus conventional preoperative contrast arteri ography (CA). Methods: The study group is composed of 23 consecutive patients who underwe nt infragenicular vein bypass grafting solely on the basis of preoperative DA from 1998 to 1999. They were compared with 50 consecutive patients who u nderwent infragenicular vein bypass grafting after CA from 1996 to 1998. Pe ak systolic velocity and end-diastolic velocity of potential target arterie s were recorded during DA studies. In situ saphenous Vein grafts were used preferentially, and technical adequacy of all grafts was assessed with comp letion duplex or arteriography. Results: DA and CA groups were comparable on the basis of age and risk fact ors. In one limb (4%), the target artery selected by DA was abandoned becau se of dense calcification. No other revision in target or inflow artery was required on the basis of intraoperative completion studies. At 1 year, pri mary graft patency (78% vs 70%, P =.72) and limb salvage (70% vs 81%, P =.2 1) were comparable between the two groups. In the DA group, mean preoperati ve target artery peak systolic velocity in patent versus failed grafts was 49 +/- 18 cm/s versus 31 +/- 9 cm/s (P =.04), whereas mean end-diastolic ve locity was 22 +/- 7 cm/s versus 14 +/- 8 cm/s (P =.08). Conclusion: Infragenicular revascularization directed by DA alone provides early graft patency and limb salvage rates comparable to similar procedures that are based on CA. Preoperative DA target artery velocities may predict outcome and improve target selection. These initial results justify furthe r clinical testing of DA as the primary imaging modality for planning infra genicular vein grafts.