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May 1995

Should All In Situ Saphenous Vein Bypasses Undergo Permanent Duplex Surveillance?

Author Affiliations

From the Section of Vascular Surgery, Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City.

Arch Surg. 1995;130(5):483-488. doi:10.1001/archsurg.1995.01430050033004

Objective:  To evaluate the need for color duplex surveillance (CDS) for pure in situ bypasses beyond 6 months.

Design:  We reviewed our in situ surveillance data from August 1987 to April 1994. Lower-extremity revascularization was performed using 245 pure in situ greater saphenous vein bypasses in 219 patients. The CDS of the entire bypass and inflow and outflow arteries was done prior to discharge, at 1 month, every 3 months in the first year, every 6 months in the second year, and annually thereafter. A peak systolic velocity of less than 45 cm/s throughout the bypass or a velocity ratio of greater than 3 (peak systolic velocity at the stenosis divided by peak systolic velocity at an adjacent normal bypass segment) were defined as abnormal during the review of this patient subset. The outcomes were analyzed. Patency and limb salvage rates were calculated by life-table analysis.

Patients:  The mean age of this population (120 men and 99 women) was 67 years (range, 32 to 97 years). We analyzed all bypasses that were subjected to CDS for 6 months or more and identified 171 such bypasses. These bypasses were followed up for a mean duration of 30 months (range, 6 to 82 months).

Results:  The primary and secondary patency and limb salvage rates at 5 years were 60.4%, 89%, and 92.1%, respectively (SE, <10%). During the first 6 months of surveillance, 54 bypasses had abnormal CDS findings, and 117 had normal CDS findings. Arteriography was performed on 42 of these bypasses with abnormal CDS findings, and 37 had significant findings requiring direct surgical or endovascular intervention. Only two of 117 bypasses that had normal CDS findings for up to 6 months had to be revised later, compared with 43 of the 54 bypasses with abnormal CDS findings prior to 6 months, which were occluded or were revised (significantly different by χ2 test [P<.001]).

Conclusions:  Vigorous CDS of pure in situ bypasses for up to 6 months is useful to detect bypass-threatening lesions. Continued CDS of a normal in situ bypass after 6 months may not be justifiable, as the incidence of lesions requiring later revision is minimal.(Arch Surg. 1995;130:483-488)