Identification of predictors for lower extremity vein graft stenosis

Andrew T. Gentile, Joseph L Mills, Michael A. Gooden, Alex Westerband, Cui Haiyan, Scott S. Berman, Glenn C. Hunter, John D Hughes

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The cause of intrinsic vein graft stenosis, which develops in at least 20% of infrainguinal autogenous bypass grafts during the intermediate follow-up interval, is unknown. We performed standard duplex surveillance of all lower extremity bypass grafts and evaluated the potential of comorbid patient risk factors that might predict development of vein graft flow disturbance or high-grade graft stenosis. METHODS: Patients with at least 6 months of postoperative duplex surveillance were identified through our vascular registry. The association of clinical and hemodynamic profiles of graft performance were compared with specific patient risk factors, including demographics, cigarette smoking, antihypertensive medical therapy, type and quality of conduit, degree of ischemia, bypass run-off, and presence of infection, using stepwise logistic regression analysis. RESULTS: Ninety- three patients (55 male, 38 female; mean age 69) underwent 100 infrainguinal bypasses. Twenty-six high-grade graft stenoses (>70%) were identified in 26 patients during follow-up (mean 21 months) by graft-flow peak systolic velocity (PSV) >300 cm/sec on more than one duplex examination, and were electively revised. Graft flow disturbances (189 cm/sec >PSV <300 cm/sec) were identified in an additional 13 grafts (6 regressed, 7 observed). The need for graft revision was associated with an early graft flow disturbance (P = 0.02), or drop in ankle-brachial index >0.15 (P = 0.03), and the use of an alternative conduit in 13 of 100 grafts (P = 0.04). Only smoking was associated with the development of a duplex detected graft flow disturbance during follow up(P = 0.03). CONCLUSION: Grafts with early flow disturbances warrant close duplex surveillance to identity graft-threatening stenosis. Risk factors that may predict future lower extremity bypass graft stenosis are smoking and the use of alternative bypass conduits.

Original languageEnglish (US)
Pages (from-to)218-221
Number of pages4
JournalAmerican Journal of Surgery
Volume174
Issue number2
DOIs
StatePublished - Aug 1997

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Lower Extremity
Veins
Pathologic Constriction
Transplants
Smoking
Antihypertensive Agents
Blood Vessels
Registries
Ischemia
Logistic Models
Hemodynamics
Regression Analysis
Demography

ASJC Scopus subject areas

  • Surgery

Cite this

Identification of predictors for lower extremity vein graft stenosis. / Gentile, Andrew T.; Mills, Joseph L; Gooden, Michael A.; Westerband, Alex; Haiyan, Cui; Berman, Scott S.; Hunter, Glenn C.; Hughes, John D.

In: American Journal of Surgery, Vol. 174, No. 2, 08.1997, p. 218-221.

Research output: Contribution to journalArticle

Gentile, AT, Mills, JL, Gooden, MA, Westerband, A, Haiyan, C, Berman, SS, Hunter, GC & Hughes, JD 1997, 'Identification of predictors for lower extremity vein graft stenosis', American Journal of Surgery, vol. 174, no. 2, pp. 218-221. https://doi.org/10.1016/S0002-9610(97)00087-1
Gentile, Andrew T. ; Mills, Joseph L ; Gooden, Michael A. ; Westerband, Alex ; Haiyan, Cui ; Berman, Scott S. ; Hunter, Glenn C. ; Hughes, John D. / Identification of predictors for lower extremity vein graft stenosis. In: American Journal of Surgery. 1997 ; Vol. 174, No. 2. pp. 218-221.
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abstract = "BACKGROUND: The cause of intrinsic vein graft stenosis, which develops in at least 20{\%} of infrainguinal autogenous bypass grafts during the intermediate follow-up interval, is unknown. We performed standard duplex surveillance of all lower extremity bypass grafts and evaluated the potential of comorbid patient risk factors that might predict development of vein graft flow disturbance or high-grade graft stenosis. METHODS: Patients with at least 6 months of postoperative duplex surveillance were identified through our vascular registry. The association of clinical and hemodynamic profiles of graft performance were compared with specific patient risk factors, including demographics, cigarette smoking, antihypertensive medical therapy, type and quality of conduit, degree of ischemia, bypass run-off, and presence of infection, using stepwise logistic regression analysis. RESULTS: Ninety- three patients (55 male, 38 female; mean age 69) underwent 100 infrainguinal bypasses. Twenty-six high-grade graft stenoses (>70{\%}) were identified in 26 patients during follow-up (mean 21 months) by graft-flow peak systolic velocity (PSV) >300 cm/sec on more than one duplex examination, and were electively revised. Graft flow disturbances (189 cm/sec >PSV <300 cm/sec) were identified in an additional 13 grafts (6 regressed, 7 observed). The need for graft revision was associated with an early graft flow disturbance (P = 0.02), or drop in ankle-brachial index >0.15 (P = 0.03), and the use of an alternative conduit in 13 of 100 grafts (P = 0.04). Only smoking was associated with the development of a duplex detected graft flow disturbance during follow up(P = 0.03). CONCLUSION: Grafts with early flow disturbances warrant close duplex surveillance to identity graft-threatening stenosis. Risk factors that may predict future lower extremity bypass graft stenosis are smoking and the use of alternative bypass conduits.",
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AU - Gentile, Andrew T.

AU - Mills, Joseph L

AU - Gooden, Michael A.

AU - Westerband, Alex

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AU - Berman, Scott S.

AU - Hunter, Glenn C.

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N2 - BACKGROUND: The cause of intrinsic vein graft stenosis, which develops in at least 20% of infrainguinal autogenous bypass grafts during the intermediate follow-up interval, is unknown. We performed standard duplex surveillance of all lower extremity bypass grafts and evaluated the potential of comorbid patient risk factors that might predict development of vein graft flow disturbance or high-grade graft stenosis. METHODS: Patients with at least 6 months of postoperative duplex surveillance were identified through our vascular registry. The association of clinical and hemodynamic profiles of graft performance were compared with specific patient risk factors, including demographics, cigarette smoking, antihypertensive medical therapy, type and quality of conduit, degree of ischemia, bypass run-off, and presence of infection, using stepwise logistic regression analysis. RESULTS: Ninety- three patients (55 male, 38 female; mean age 69) underwent 100 infrainguinal bypasses. Twenty-six high-grade graft stenoses (>70%) were identified in 26 patients during follow-up (mean 21 months) by graft-flow peak systolic velocity (PSV) >300 cm/sec on more than one duplex examination, and were electively revised. Graft flow disturbances (189 cm/sec >PSV <300 cm/sec) were identified in an additional 13 grafts (6 regressed, 7 observed). The need for graft revision was associated with an early graft flow disturbance (P = 0.02), or drop in ankle-brachial index >0.15 (P = 0.03), and the use of an alternative conduit in 13 of 100 grafts (P = 0.04). Only smoking was associated with the development of a duplex detected graft flow disturbance during follow up(P = 0.03). CONCLUSION: Grafts with early flow disturbances warrant close duplex surveillance to identity graft-threatening stenosis. Risk factors that may predict future lower extremity bypass graft stenosis are smoking and the use of alternative bypass conduits.

AB - BACKGROUND: The cause of intrinsic vein graft stenosis, which develops in at least 20% of infrainguinal autogenous bypass grafts during the intermediate follow-up interval, is unknown. We performed standard duplex surveillance of all lower extremity bypass grafts and evaluated the potential of comorbid patient risk factors that might predict development of vein graft flow disturbance or high-grade graft stenosis. METHODS: Patients with at least 6 months of postoperative duplex surveillance were identified through our vascular registry. The association of clinical and hemodynamic profiles of graft performance were compared with specific patient risk factors, including demographics, cigarette smoking, antihypertensive medical therapy, type and quality of conduit, degree of ischemia, bypass run-off, and presence of infection, using stepwise logistic regression analysis. RESULTS: Ninety- three patients (55 male, 38 female; mean age 69) underwent 100 infrainguinal bypasses. Twenty-six high-grade graft stenoses (>70%) were identified in 26 patients during follow-up (mean 21 months) by graft-flow peak systolic velocity (PSV) >300 cm/sec on more than one duplex examination, and were electively revised. Graft flow disturbances (189 cm/sec >PSV <300 cm/sec) were identified in an additional 13 grafts (6 regressed, 7 observed). The need for graft revision was associated with an early graft flow disturbance (P = 0.02), or drop in ankle-brachial index >0.15 (P = 0.03), and the use of an alternative conduit in 13 of 100 grafts (P = 0.04). Only smoking was associated with the development of a duplex detected graft flow disturbance during follow up(P = 0.03). CONCLUSION: Grafts with early flow disturbances warrant close duplex surveillance to identity graft-threatening stenosis. Risk factors that may predict future lower extremity bypass graft stenosis are smoking and the use of alternative bypass conduits.

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