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A Journal on Surgery

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Chirurgia 2006 April;19(2):135-9


language: English

Predictive value of the first duplex-scan in the follow-up of infrainguinal venous bypasses

Vega de Céniga M. 1, Sánchez Hervás L. 2, Javier Serrano F. 2, Bañón RN M. 2, Rial R. 2, Reina T. 2

1 Department of Angiology and Vascular Surgery Hospital de Galdakao, Bizkaia, Spain 2 Department of Angiology and Vascular Surgery Hospital Clínico San Carlos, Madrid, Spain


Aim. Our objective was to assess the predictive value of the first duplex-scan (1DS) performed in the follow-up of venous bypasses on the incidence of late occlusion or hemodynamic failure.
Methods. Prospective clinical registry and protocolised duplex-scan surveillance of vein-grafts (1998-2001). Setting: Hospitalized follow-up of vascular patients with infrainguinal venous bypasses. We analysed 110 bypasses, with a follow-up of 23.3±13.4 months. Diagnostic criteria: Normal (N)- PSV(cm/s)<=150, PSV-ratio<=1.5, n=60(54.6%); Low-Grade stenoses (LG)- PSV 151-300, PSV-ratio 1.6-3.5, n=36(32.7%); Severe stenoses (S)- PSV>300, PSV-ratio>3.5, n=13(11.8%). One bypass (0.9%) was found to be occluded in the first control. Statistical analysis: lifetables, Kaplan-Meier, log-rank; T test; ROC curves.
Results. During the follow-up, 21 events (occlusion/hemodynamic failure) occurred in group N, 18 in group LG, 13 in group S. Thus: sensitivity-46.2%, specificity-68.4%, positive predictive value-50%, negative predictive value-65%. Bypasses in group LG showed lower primary patency rates (p1) than those in group N (RR=2; 95%CI1.04-3.83; p=0.037). Also, distal graft diameter <3 mm and location of the lesion in the distal anastomosis were associated with lower p1 in group LG (p=0.035, 0.036).
Conclusions. The detection of low-grade stenoses in 1 DS has been associated with a significantly higher incidence of late occlusion or hemodynamic failure. Small vein-graft diameter (<3 mm) and defects in the distal anastomosis worsen the prognosis. However, predictive value of 1 DS is low and close surveillance of all vein-grafts is necessary, at least during the first year, because of possible late severe stenoses.

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