Vascular surgical society of great britain and ireland: duplex surveillance does not enhance infrainguinal prosthetic bypass graft patency

BACKGROUND: All patients discharged from this unit with a patent infrainguinal polytetrafluoroethylene (PTFE) bypass are entered into a graft surveillance programme. Previous internal audit had suggested that duplex surveillance was not worthwhile in this patient group. The aim of this study was to compare the fate of infrainguinal PTFE grafts before and after stopping duplex surveillance. METHODS: Between January 1986 and December 1994, 220 grafts (141 above-knee popliteal, 69 below-knee popliteal, ten tibial) were entered into the duplex surveillance programme. Between January 1995 and June 1996, 56 further grafts (29 above-knee popliteal, 21 below-knee popliteal, six tibial) were followed prospectively without duplex scans. RESULTS: During the first study interval, an 'abnormal' scan was reported in 66 of 220 grafts. For clinical reasons (no further reconstruction feasible), no intervention was undertaken in 56 patients. Of these, 34 grafts occluded and 17 amputations were performed. An intervention to maintain patency was performed in ten patients. In 154 patients with 'normal' scans, 53 grafts occluded and 21 amputations were performed. During the second study interval, 20 grafts occluded and 12 amputations were performed. In six patients, an attempt was made to re-establish patency and this was successful in two. Kaplan-Meier 36-month primary and secondary patency rates were 48 and 51 per cent respectively for the group that underwent duplex surveillance, and 58 and 60 per cent for the group that was followed without duplex imaging. CONCLUSION: Prospective duplex surveillance of infrainguinal PTFE bypass grafts does not enhance graft patency and cannot be justified.