[Postoperative digital subtraction angiography after infrainguinal bypass operation].

Bypass occlusions in infrainguinal arterial reconstructions occur in up to 20% within the first postoperative month and are caused by technical defects in most cases. In a prospective study to evaluate the importance of imaging techniques in infrainguinal bypass grafting 81 of 103 bypasses were examined by intraarterial DSA 10 days postoperatively. The findings of early postoperative DSA were compared with the results of intraoperative angioscopy and completion angiography. In 11 cases (13.6%) there were additional pathological findings. In 6 patients stenoses were localized at the proximal anastomosis, which could not be visualized intraoperatively due to technical reasons. In 2 more patients postoperative DSA revealed an occlusion of the distal segment of the recipient artery with a retrograde blood flow in the proximal segment. Further pathological findings were one perianastomotic stenosis caused by a thrombus at a venous valve site and one arteriovenous fistula in an in-situ-bypass. In one more patient angiography showed a stenosis in the outflow tract. The duplex-derived PSV, however, was normal and no revision was made. At present, examination of the proximal anastomosis is possible by intraoperative DSA, but initially unrecognized and secondary bypass defects can only be identified by early postoperative DSA in asymptomatic patients. A final scrutiny of the arterial reconstruction can be achieved by postoperative DSA without any recognizable morbidity before subsequent bypass function is monitored by non invasive methods like duplex sonography.