Have the results of infrainguinal bypass improved with the widespread utilisation of postoperative surveillance?

Objectives: The objectives of this study were to assess the impact of Duplex surveillance on the results of infrainguinal vein grafts. A review has been performed comparing the outcome of vein grafts undergoing Duplex surveillance phs prophylactic treatment of stenoses to that of-vein grafts followed clinically Design, patients and methods: Only studies providing information on occlusion rates were included. Mortality and limb salvage rates were also analysed but were not available from all studies. Results: 2680 surveillance and 3969 non-surveillance vein grafts were analysed. There was no significant difference between the two groups with respect to presence of-critical ischaemia (p = 0.3) and level of distal anastomosis (p > 0.5). Surveillance identified 493 stenoses in 469 (19%) grafts, 397 (16%) grafts were treated by surgery (248; 62%) and angioplasty (149; 38%). Ninety-eight (26%) grafts developed recurrent stenoses. Total number of deaths, fetal number of occluded grafts and number of occlusions after 30 days were significantly greater for the non-surveillance group (p<0.001; p<0.001; p<0.01). Perioperative occlusion rates were not significantly different (p = 0.1). Few surveillance studies reported limb salvage rates (6 of 17). The numbers of amputations were not significantly diiferent between the two groups (p > 0.5). Conclusions: The patency of infrainguinal vein grafts would appear to be improved as a result of surveillance. However, no improvement in limb salvage has been demonstrated.