Comparison of clinical follow-up and duplex surveillance of infrainguinal vein bypasses

Abstract

The evidence in support of surveillance has been principally based on the favourable primary-assisted patency of stenosed grafts following revision (60-80% at 5 years) compared with the poor secondary patency of revised occluded grafts (20-40% at 5 years). Both the capital cost and workload generated by surveillance are considerable. More information is needed on the benefits of surveillance compared with clinical follow-up. A retrospective comparison of 50 vein grafts (44 reversed, six in situ) undergoing colour-coded duplex surveillance and 50 vein grafts (46 reversed, four in situ) under clinical follow-up, with duplex scans obtained only when clinically indicated, has been performed. Four (8%) stenoses of > or = 50% were identified in the surveillance group. One 50% proximal anastomotic stenosis failed to progress on sequential scans. Three stenoses were treated (one mid graft, two popliteal) by vein patch angioplasty (two cases) and transluminal angioplasty (one case). Both groups were followed-up for 12 months. Secondary patency at 12 months (88% surveillance; 80% clinical follow-up) was not significantly different (P = 0.3). Similarly, limb salvage at 12 months (94% surveillance; 88% controls) was not significantly different (P = 0.4). A large randomized prospective study comparing duplex surveillance and clinical follow-up is warranted.