Lower extremity bypass graft revision in diabetics

B. Toursarkissian, M. D'Ayala, Paula K Shireman, J. Schoolfield, M. T. Sykes

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Revision of lower extremity bypass graft stenoses identified by surveillance duplex scanning is frequently required in diabetic patients. The authors evaluated (1) the value of routine angiography before graft revision in diabetics, (2) factors that predict patients in whom angiography alters management, and (3) the incidence of recurrent stenosis and factors that might predict it. Forty-two infrainguinal primary vein bypasses undergoing primary revision were retrospectively studied. The initial graft stenosis was detected at a mean of 11.5 ±3.6 months after the original bypass. Angiograms were obtained in 38 cases, revealing additional findings in 29 of 38 cases (76%), with a resultant alteration of the operative plan in 27 cases (71%). The most frequent additional angiographic finding was the identification or localization of a lesion in the inflow or outflow tracts (18 of 27 cases). Cases where the angiogram altered the management plan had a mean systolic velocity ratio across the stenosis (Vr) of 7.3 ±6.1, versus a Vr of 4.8 ±1.3 for cases where the angiogram did not alter the management plan (p < 0.04). Duplex scanning identified 4 lesions that were not seen on angiography; 3 of 4 were confirmed as webs at surgery. Twenty of 42 grafts (48%) developed recurrent stenoses at a mean of 4.9 ±3.8 months from initial revision. Restenosis occurred in 69% of female limbs as compared to 38% of male limbs (p = 0.06). Recurrent stenosis was not a predictor of ultimate graft failure, unless left untreated. Four of 10 untreated grafts ultimately failed. A total of 9 of the 42 grafts eventually failed (21%), leading to 3 amputations (7%). The authors conclude that failing infrainguinal bypass grafts identified by duplex in diabetics should undergo a detailed angiographic evaluation. This frequently leads to an alteration in the management plan, especially in the presence of a high Vr across stenoses. High rates of limb salvage (93%) and assisted primary graft patency (79%) despite a high recurrent stenoses rate (48%) justify routine duplex surveillance, preoperative angiography, and aggressive graft revision in diabetic patients with infrainguinal grafts.

Original languageEnglish (US)
Pages (from-to)369-377
Number of pages9
JournalVascular Surgery
Volume35
Issue number5
StatePublished - 2001

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Lower Extremity
Transplants
Pathologic Constriction
Angiography
Extremities
Limb Salvage
Amputation
Veins
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Toursarkissian, B., D'Ayala, M., Shireman, P. K., Schoolfield, J., & Sykes, M. T. (2001). Lower extremity bypass graft revision in diabetics. Vascular Surgery, 35(5), 369-377.

Lower extremity bypass graft revision in diabetics. / Toursarkissian, B.; D'Ayala, M.; Shireman, Paula K; Schoolfield, J.; Sykes, M. T.

In: Vascular Surgery, Vol. 35, No. 5, 2001, p. 369-377.

Research output: Contribution to journalArticle

Toursarkissian, B, D'Ayala, M, Shireman, PK, Schoolfield, J & Sykes, MT 2001, 'Lower extremity bypass graft revision in diabetics', Vascular Surgery, vol. 35, no. 5, pp. 369-377.
Toursarkissian B, D'Ayala M, Shireman PK, Schoolfield J, Sykes MT. Lower extremity bypass graft revision in diabetics. Vascular Surgery. 2001;35(5):369-377.
Toursarkissian, B. ; D'Ayala, M. ; Shireman, Paula K ; Schoolfield, J. ; Sykes, M. T. / Lower extremity bypass graft revision in diabetics. In: Vascular Surgery. 2001 ; Vol. 35, No. 5. pp. 369-377.
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