The progression and correction of duplex detected velocity shifts in angiographically normal vein grafts
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OBJECTIVES: To review the sensitivity of duplex scanning and angiography at detecting vein graft stenoses in patients on a graft surveillance programme. DESIGN: Prospective, open, non-randomised study. PATIENTS AND METHODS: Since February 1993, 143 patients with 148 grafts (70% in situ, 30% reversed) have attended postoperative infrainguinal vein graft surveillance for a minimum of 6 weeks. Fifty-seven graft stenoses in 57 grafts were identified by duplex scanning as a localised high velocity jet. Angiography was performed in all except 12 patients. RESULTS: Angiography confirmed a duplex abnormality in all but 10 patients. Of these, five patients remain stable and asymptomatic with a persisting duplex abnormality. The remaining five patients, although asymptomatic, exhibited disease progression on duplex and surgical intervention confirmed significant stenoses, which were successfully treated. CONCLUSION: The results suggest that duplex scanning is a reliable imaging modality for detecting vein graft stenoses. Selection for surgical correction can be made, in some circumstances on the basis of clinical and ultrasound criteria alone.
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