Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique

A. K. Gupta, D. F. Bandyk, D. Cheanvechai, B. L. Johnson, J. B. Towne, Joseph L Mills, A. H. Davies

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Purpose: To determine whether the incidence of vein graft stenosis is related to bypass grafting technique and thus modification of postoperative surveillance protocols may be required. Methods: From 1991 to 1996, 338 infrainguinal vein bypasses constructed using in situ (n = 131), reversed (n = 120), nonreversed translocated (n = 48), or spliced/upper extremity vein (n = 39) grafting techniques were evaluated by intraoperative duplex scanning to optimize bypass construction and serially thereafter to detect developing vein graft stenoses. Bypass procedures were performed in 322 patients for critical limb ischemia (83%), claudication (13%), or popliteal aneurysm (4%). Using life-table analysis, graft patency and revision/failure rates were compared relative to grafting technique, need for operative revision, and intraoperative duplex scan results. Results: Three-year primary and secondary graft patency rates were higher (p < 0.001) for in situ bypass grafts (85%/97%) compared with reversed (57%/83%), nonreversed translocated (62%/78%), or alternative (51%/76%) vein bypass grafts. During a mean follow- up interval of 19 months, the incidence of graft revision was higher for reversed saphenous (23%) and alternative (28%) vein bypass grafts compared with in situ (10%) or nonreversed (16%) saphenous vein bypass grafts. Despite a normal intraoperative graft duplex scan, the revision/failure rate of reversed vein grafts was 2.5 times greater than in situ/nonreversed translocated vein conduits (primary patency rate at 3 years, 60% vs 87%, p = 0.009). Bypass grafts modified at operation on the basis of duplex scanning were two times more likely to require postoperative revision than grafts with normal intraoperative scans. Conclusions: The incidence of postoperative graft stenosis and need for revision varies with bypass grafting technique. Reversed vein bypasses and grafts modified at operation may be more prone than in situ vein bypass grafts to develop stenosis and thus require intensive surveillance. Infrainguinal vein graft failure and the need for revision may be reduced by the adoption of bypass grafting techniques that include valve lysis and intraoperative duplex scan assessment.

Original languageEnglish (US)
Pages (from-to)211-225
Number of pages15
JournalJournal of Vascular Surgery
Volume25
Issue number2
DOIs
StatePublished - 1997
Externally publishedYes

Fingerprint

Natural History
Veins
Pathologic Constriction
Transplants
Incidence
Life Tables
Saphenous Vein
Upper Extremity
Aneurysm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Gupta, A. K., Bandyk, D. F., Cheanvechai, D., Johnson, B. L., Towne, J. B., Mills, J. L., & Davies, A. H. (1997). Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique. Journal of Vascular Surgery, 25(2), 211-225. https://doi.org/10.1016/S0741-5214(97)70344-6

Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique. / Gupta, A. K.; Bandyk, D. F.; Cheanvechai, D.; Johnson, B. L.; Towne, J. B.; Mills, Joseph L; Davies, A. H.

In: Journal of Vascular Surgery, Vol. 25, No. 2, 1997, p. 211-225.

Research output: Contribution to journalArticle

Gupta, AK, Bandyk, DF, Cheanvechai, D, Johnson, BL, Towne, JB, Mills, JL & Davies, AH 1997, 'Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique', Journal of Vascular Surgery, vol. 25, no. 2, pp. 211-225. https://doi.org/10.1016/S0741-5214(97)70344-6
Gupta, A. K. ; Bandyk, D. F. ; Cheanvechai, D. ; Johnson, B. L. ; Towne, J. B. ; Mills, Joseph L ; Davies, A. H. / Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique. In: Journal of Vascular Surgery. 1997 ; Vol. 25, No. 2. pp. 211-225.
@article{74a7ad5568234e68818a7ddfcd6a5566,
title = "Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique",
abstract = "Purpose: To determine whether the incidence of vein graft stenosis is related to bypass grafting technique and thus modification of postoperative surveillance protocols may be required. Methods: From 1991 to 1996, 338 infrainguinal vein bypasses constructed using in situ (n = 131), reversed (n = 120), nonreversed translocated (n = 48), or spliced/upper extremity vein (n = 39) grafting techniques were evaluated by intraoperative duplex scanning to optimize bypass construction and serially thereafter to detect developing vein graft stenoses. Bypass procedures were performed in 322 patients for critical limb ischemia (83{\%}), claudication (13{\%}), or popliteal aneurysm (4{\%}). Using life-table analysis, graft patency and revision/failure rates were compared relative to grafting technique, need for operative revision, and intraoperative duplex scan results. Results: Three-year primary and secondary graft patency rates were higher (p < 0.001) for in situ bypass grafts (85{\%}/97{\%}) compared with reversed (57{\%}/83{\%}), nonreversed translocated (62{\%}/78{\%}), or alternative (51{\%}/76{\%}) vein bypass grafts. During a mean follow- up interval of 19 months, the incidence of graft revision was higher for reversed saphenous (23{\%}) and alternative (28{\%}) vein bypass grafts compared with in situ (10{\%}) or nonreversed (16{\%}) saphenous vein bypass grafts. Despite a normal intraoperative graft duplex scan, the revision/failure rate of reversed vein grafts was 2.5 times greater than in situ/nonreversed translocated vein conduits (primary patency rate at 3 years, 60{\%} vs 87{\%}, p = 0.009). Bypass grafts modified at operation on the basis of duplex scanning were two times more likely to require postoperative revision than grafts with normal intraoperative scans. Conclusions: The incidence of postoperative graft stenosis and need for revision varies with bypass grafting technique. Reversed vein bypasses and grafts modified at operation may be more prone than in situ vein bypass grafts to develop stenosis and thus require intensive surveillance. Infrainguinal vein graft failure and the need for revision may be reduced by the adoption of bypass grafting techniques that include valve lysis and intraoperative duplex scan assessment.",
author = "Gupta, {A. K.} and Bandyk, {D. F.} and D. Cheanvechai and Johnson, {B. L.} and Towne, {J. B.} and Mills, {Joseph L} and Davies, {A. H.}",
year = "1997",
doi = "10.1016/S0741-5214(97)70344-6",
language = "English (US)",
volume = "25",
pages = "211--225",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique

AU - Gupta, A. K.

AU - Bandyk, D. F.

AU - Cheanvechai, D.

AU - Johnson, B. L.

AU - Towne, J. B.

AU - Mills, Joseph L

AU - Davies, A. H.

PY - 1997

Y1 - 1997

N2 - Purpose: To determine whether the incidence of vein graft stenosis is related to bypass grafting technique and thus modification of postoperative surveillance protocols may be required. Methods: From 1991 to 1996, 338 infrainguinal vein bypasses constructed using in situ (n = 131), reversed (n = 120), nonreversed translocated (n = 48), or spliced/upper extremity vein (n = 39) grafting techniques were evaluated by intraoperative duplex scanning to optimize bypass construction and serially thereafter to detect developing vein graft stenoses. Bypass procedures were performed in 322 patients for critical limb ischemia (83%), claudication (13%), or popliteal aneurysm (4%). Using life-table analysis, graft patency and revision/failure rates were compared relative to grafting technique, need for operative revision, and intraoperative duplex scan results. Results: Three-year primary and secondary graft patency rates were higher (p < 0.001) for in situ bypass grafts (85%/97%) compared with reversed (57%/83%), nonreversed translocated (62%/78%), or alternative (51%/76%) vein bypass grafts. During a mean follow- up interval of 19 months, the incidence of graft revision was higher for reversed saphenous (23%) and alternative (28%) vein bypass grafts compared with in situ (10%) or nonreversed (16%) saphenous vein bypass grafts. Despite a normal intraoperative graft duplex scan, the revision/failure rate of reversed vein grafts was 2.5 times greater than in situ/nonreversed translocated vein conduits (primary patency rate at 3 years, 60% vs 87%, p = 0.009). Bypass grafts modified at operation on the basis of duplex scanning were two times more likely to require postoperative revision than grafts with normal intraoperative scans. Conclusions: The incidence of postoperative graft stenosis and need for revision varies with bypass grafting technique. Reversed vein bypasses and grafts modified at operation may be more prone than in situ vein bypass grafts to develop stenosis and thus require intensive surveillance. Infrainguinal vein graft failure and the need for revision may be reduced by the adoption of bypass grafting techniques that include valve lysis and intraoperative duplex scan assessment.

AB - Purpose: To determine whether the incidence of vein graft stenosis is related to bypass grafting technique and thus modification of postoperative surveillance protocols may be required. Methods: From 1991 to 1996, 338 infrainguinal vein bypasses constructed using in situ (n = 131), reversed (n = 120), nonreversed translocated (n = 48), or spliced/upper extremity vein (n = 39) grafting techniques were evaluated by intraoperative duplex scanning to optimize bypass construction and serially thereafter to detect developing vein graft stenoses. Bypass procedures were performed in 322 patients for critical limb ischemia (83%), claudication (13%), or popliteal aneurysm (4%). Using life-table analysis, graft patency and revision/failure rates were compared relative to grafting technique, need for operative revision, and intraoperative duplex scan results. Results: Three-year primary and secondary graft patency rates were higher (p < 0.001) for in situ bypass grafts (85%/97%) compared with reversed (57%/83%), nonreversed translocated (62%/78%), or alternative (51%/76%) vein bypass grafts. During a mean follow- up interval of 19 months, the incidence of graft revision was higher for reversed saphenous (23%) and alternative (28%) vein bypass grafts compared with in situ (10%) or nonreversed (16%) saphenous vein bypass grafts. Despite a normal intraoperative graft duplex scan, the revision/failure rate of reversed vein grafts was 2.5 times greater than in situ/nonreversed translocated vein conduits (primary patency rate at 3 years, 60% vs 87%, p = 0.009). Bypass grafts modified at operation on the basis of duplex scanning were two times more likely to require postoperative revision than grafts with normal intraoperative scans. Conclusions: The incidence of postoperative graft stenosis and need for revision varies with bypass grafting technique. Reversed vein bypasses and grafts modified at operation may be more prone than in situ vein bypass grafts to develop stenosis and thus require intensive surveillance. Infrainguinal vein graft failure and the need for revision may be reduced by the adoption of bypass grafting techniques that include valve lysis and intraoperative duplex scan assessment.

UR - http://www.scopus.com/inward/record.url?scp=0031048998&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031048998&partnerID=8YFLogxK

U2 - 10.1016/S0741-5214(97)70344-6

DO - 10.1016/S0741-5214(97)70344-6

M3 - Article

C2 - 9052556

AN - SCOPUS:0031048998

VL - 25

SP - 211

EP - 225

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 2

ER -