Doppler Flow Waveform Analysis Aids in Early Detection of Late Graft Failure in Cases of Lower Extremity Arterial Reconstruction: Case Studies

Abstract

From 1977 through 1986, 221 patients undergoing arterial reconstructions of the lower extremities, including 78 aortofemoral, 121 femoral-distal, and 22 extraanatomic reconstructions, were followed up after discharge, by use of Doppler driven flow waveform analysis and the ankle pressure index. In 40 (18%) of 221 patients, deterioration in the flow waveform pattern was detected, 5 aortofemoral (6.4%), 31 femoral-distal (25.6%), and 4 extraanatomic (18.2%) reconstructions, respectively. In 37 patients, changes in the flow waveform pat tern were detected within two and a half years after the initial surgery, and in those with a type II flow waveform pattern at the time of discharge, there was a greater tendency toward deterioration of flow waveform pattern. In 32 patients, the ankle pressure index decreased in parallel with deterioration in the flow waveform pattern. The remaining 8 patients (20%) showed no decrease in the ankle pressure index, despite a deterioration in the flow waveform pattern. In the 26 patients who consented, immediate arteriography identified the cause of the hemodynamic failure as localized graft stenosis, including the anastomotic site in 10 patients, inadequate outflow in 7, poor inflow in 6, combined graft stenosis and poor outflow in 2, and combined poor inflow and outflow in 1. Reoperation was performed in 23 patients and was successful in correcting the hemodynamic failure. The results of this study suggest that Doppler driven flow waveform analysis is preferable to ankle pressure index assessment for detect ing early stenotic lesions of the reconstructed artery and that patients with the type II flow waveform pattern should be closely followed up.