Early duplex-derived hemodynamic parameters after lower extremity bypass in diabetics: Implications for mid-term outcomes

Boulos Toursarkissian, Dimitri Stefanidis, Ryan T. Hagino, Marcus D'Ayala, John Schoolfield, Paula K Shireman, Mellick T. Sykes

Research output: Contribution to journalArticle

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Abstract

Early postoperative changes in the hemodynamic parameters of infrainguinal bypass grafts in diabetics have not been well defined. We undertook this study to better define such changes in duplex-derived velocities and waveforms, and correlate any observed changes with intermediate-term outcomes. A prospective study of 68 primary vein bypasses for limb salvage was carried out, with scans obtained intraoperatively, daily until discharge, and at 8- to 12-weeks intervals. During follow-up (12 ± 6 months), 20 grafts developed stenoses, 17 occluded, and 8 limbs were amputated. Most grafts show a variant of a biphasic waveform intraoperatively at the mid-graft (MG) and distal graft (DG) levels (54% and 57%); 65% of waveforms remain unchanged during the first week, and 54% remain unchanged at 3 months. No duplex-derived factors were predictive of the development of stenoses. A number of parameters were predictive of ultimate graft thrombosis. Intraoperative MG velocity was higher in grafts that eventually remained patent (83 ± 36 vs. 60 ± 29 cm/sec; p < 0.025). Grafts that remained patent also had a much lower decline in DG and distal native (DN) velocities from immediately postoperative to 8-12 weeks later, than grafts that eventually thrombosed (-3 ± 35 vs. -44 ± 43 cm/sec for DG, p < 0.001; and -17 ± 66 vs. -76 ± 53 cm/sec for DN, p < 0.04 respectively). In terms of limb salvage, when the MG or DG waveform worsened (from postoperation to 12 weeks later), amputation was more likely than when it remained unchanged or improved (MG 67% vs. 9% limb loss, p < 0.04; DG 43% vs. 8% limb loss, p < 0.04). We conclude that intensive graft duplex surveillance does not identify grafts likely to develop stenoses. However, a number of features allow the prediction of ultimate graft failure or limb loss.

Original languageEnglish (US)
Pages (from-to)601-607
Number of pages7
JournalAnnals of Vascular Surgery
Volume16
Issue number5
DOIs
StatePublished - Sep 2002

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Lower Extremity
Hemodynamics
Transplants
Extremities
Limb Salvage
Pathologic Constriction
Thrombosis
Amputation
Veins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Early duplex-derived hemodynamic parameters after lower extremity bypass in diabetics : Implications for mid-term outcomes. / Toursarkissian, Boulos; Stefanidis, Dimitri; Hagino, Ryan T.; D'Ayala, Marcus; Schoolfield, John; Shireman, Paula K; Sykes, Mellick T.

In: Annals of Vascular Surgery, Vol. 16, No. 5, 09.2002, p. 601-607.

Research output: Contribution to journalArticle

Toursarkissian, Boulos ; Stefanidis, Dimitri ; Hagino, Ryan T. ; D'Ayala, Marcus ; Schoolfield, John ; Shireman, Paula K ; Sykes, Mellick T. / Early duplex-derived hemodynamic parameters after lower extremity bypass in diabetics : Implications for mid-term outcomes. In: Annals of Vascular Surgery. 2002 ; Vol. 16, No. 5. pp. 601-607.
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abstract = "Early postoperative changes in the hemodynamic parameters of infrainguinal bypass grafts in diabetics have not been well defined. We undertook this study to better define such changes in duplex-derived velocities and waveforms, and correlate any observed changes with intermediate-term outcomes. A prospective study of 68 primary vein bypasses for limb salvage was carried out, with scans obtained intraoperatively, daily until discharge, and at 8- to 12-weeks intervals. During follow-up (12 ± 6 months), 20 grafts developed stenoses, 17 occluded, and 8 limbs were amputated. Most grafts show a variant of a biphasic waveform intraoperatively at the mid-graft (MG) and distal graft (DG) levels (54{\%} and 57{\%}); 65{\%} of waveforms remain unchanged during the first week, and 54{\%} remain unchanged at 3 months. No duplex-derived factors were predictive of the development of stenoses. A number of parameters were predictive of ultimate graft thrombosis. Intraoperative MG velocity was higher in grafts that eventually remained patent (83 ± 36 vs. 60 ± 29 cm/sec; p < 0.025). Grafts that remained patent also had a much lower decline in DG and distal native (DN) velocities from immediately postoperative to 8-12 weeks later, than grafts that eventually thrombosed (-3 ± 35 vs. -44 ± 43 cm/sec for DG, p < 0.001; and -17 ± 66 vs. -76 ± 53 cm/sec for DN, p < 0.04 respectively). In terms of limb salvage, when the MG or DG waveform worsened (from postoperation to 12 weeks later), amputation was more likely than when it remained unchanged or improved (MG 67{\%} vs. 9{\%} limb loss, p < 0.04; DG 43{\%} vs. 8{\%} limb loss, p < 0.04). We conclude that intensive graft duplex surveillance does not identify grafts likely to develop stenoses. However, a number of features allow the prediction of ultimate graft failure or limb loss.",
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