Duplex Ultrasound Surveillance after Axillofemoral Bypass

Abstract

Objective

—There are limited data available in the literature on duplex imaging after axillofemoral bypass grafting. We sought to explore this topic and identify duplex findings predictive of graft failure.

Methods

—All patients who underwent axillo-femoral or bifemoral prosthetic bypass procedures during an 9-year period and returned for follow-up duplex ultrasound scans (U/S) were included. Protocol based testing included ankle brachial indices, toe pressures, and duplex velocities at proximal anastomosis, mid-axillary graft, and femoral anastomosis sites.

Results

—Forty-seven patients underwent axillo-femoral bypass prosthetic procedures and returned for follow-up U/S. Mean follow-up was 61 ± 180 months (range, 1–1232) with a mean number of postoperative U/S of 4.5 per person ± 3.6 (range, 1–16). Eight bypass grafts (17%) occluded, i.e., 4 ax-bifemoral segments and 4 femoral-femoral segments. Two of eight occluded patients had not returned for postoperative U/S until occlusion occurred. Of the other 6 patients who underwent postoperative U/S before occlusion, all but one had midgraft peak systolic velocities of <85 cm/sec. Considering all patients evaluated with at least one postoperative examination, midgraft axillary femoral bypass velocities were predictive of future graft failure (p = 0.0001) with occlusion occurring in 66% (5 of 8) of those with velocities <85 cm/sec, and 1 patient (1/37) with velocities >85 cm/sec. Two patients had velocities <85 cm/sec and remained patent. Six patients had abnormal studies (peak systolic velocities >250 cm/sec) but that did not progress to failure at follow-up. One patient had a para-anasatamotic aneurysm that was identified during follow-up that was treated by endovascular grafting.

Conclusion

—Midgraft axillary femoral bypass velocities are predictive of future graft failure.