Graft surveillance does not identify lesions

Diabetic Foot, The,  Summer, 2008  by Carter A,   Murphy,   Halka

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1. Graft surveillance identifies which grafts are at risk of failure, but there is controversy over which grafts benefit most from surveillance.

2. This study aimed to investigate the natural history of graft failure following myointimal hyperplasia and to identify risk factors and prevalent time periods for graft failure.

3. The authors analysed 212 infrainguinal skin grafts in 197 people.

4. In total, 21.6% of grafts occluded, 16% underwent a salvage procedure (40.5% of these at 6 months following surgery) and 56.6% were preceded by a stenotic lesion.

5. Primary occlusions were more common in the prosthetic group (95.9%) than the femorocrural group (66.5%).

6. Vein graft failures were most likely to be preceded by a progressive stenosis (58.3%), which formed most commonly at the proximal anastomosis. Over 40% of stenoses resolved or did not progress.

7. Overall, 56.2% of grafts remained stenosis free, with few occurring in the prosthetic group.

8. Post-operative use of statins reduced stenosis and occlusion occurrence, particularly in grafts above the knee (P=0.03). Smoking status or presence of diabetes were not found to be risk factors.

9. Graft surveillance detects stenoses in vein grafts likely to fail without intervention, but does not identify lesions prior to occlusion in the majority of prosthetic and femorocrural grafts.

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Carter A. Murphy MO, Halka AT (2007) The natural history of stenoses within lower limb arterial bypass grafts using a graft surveillance program. Annals of Vascular Surgery 21: 695-703

COPYRIGHT 2008 S.B. Communications
COPYRIGHT 2008 Gale, Cengage Learning