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 language | English (US) |
|---|---|
| Pages (from-to) | 601-607 |
| Number of pages | 7 |
| Journal | Annals of Vascular Surgery |
| Volume | 16 |
| Issue number | 5 |
| DOIs | |
| State | Published - Sep 2002 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
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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 journal › Article
}
TY - JOUR
T1 - Early duplex-derived hemodynamic parameters after lower extremity bypass in diabetics
T2 - Implications for mid-term outcomes
AU - Toursarkissian, Boulos
AU - Stefanidis, Dimitri
AU - Hagino, Ryan T.
AU - D'Ayala, Marcus
AU - Schoolfield, John
AU - Shireman, Paula K
AU - Sykes, Mellick T.
PY - 2002/9
Y1 - 2002/9
N2 - 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.
AB - 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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UR - http://www.scopus.com/inward/citedby.url?scp=0036711150&partnerID=8YFLogxK
U2 - 10.1007/s10016-001-0272-8
DO - 10.1007/s10016-001-0272-8
M3 - Article
C2 - 12183777
AN - SCOPUS:0036711150
VL - 16
SP - 601
EP - 607
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
SN - 0890-5096
IS - 5
ER -