Vein graft surveillance improves patency in femoro-popliteal bypass.

Sixty-three patients undergoing femoro-popliteal bypass using autologous vein were prospectively screened for the development of graft related strictures by clinical assessment, intravenous digital subtraction angiography (IVDSA) and Duplex scanning. Eighteen strictures were identified in 14 grafts. Clinical examination detected only 11% of lesions, IVDSA detected 83% of lesions and Duplex scanning detected all 18 lesions. Seventeen lesions had occurred by 6 months from the time of operation which suggests that screening should begin early. Treatment by percutaneous transluminal angioplasty (PTA) was offered for eight strictures and dilatation was complete in all cases. No stricture recurred in the follow-up period. Cumulative patency in this series of screened and selectively treated vein grafts was compared with a previous series of 216 femoro-popliteal vein grafts and an improvement in 1 year potency of 15% was achieved (log rank test, chi 2 = 5.12, P = 0.02).