Progression of occlusive disease following femorofemoral crossover bypass graft

Progression of distal disease is considered the most common cause of femorofemoral artery cross-over bypass graft (FFBPG) failure. Twenty-seven patients with patent grafts (mean 53 months) were evaluated with segmental Doppler and duplex scan arterial studies for evidence of disease progression. In the early postoperative period (compared with preoperative levels), 26 patients (95.3%) showed a significant improvement (>0.1) in the recipient limb ankle-brachial index (ABI) (mean increase of 0.38; SD=0.24) and/or ankle spectral arterial waveform. However, there was a statistically significant decrease (p=0.0001) in the donor limb ABI, and 12 patients (44.4%) had a >0.1 deterioration. On long-term follow-up (compared with preoperative levels) this difference was no longer significant (p=0.49); only seven donor limbs remained with a >0.1 decrease in ABI. The recipient limbs maintained a significant improvement (>0.1) in the ABI compared to preoperative levels (p<0.0001; mean of 0.39; SD=0.16) except for three limbs that had decreased by 0.1. However, eight patients (29.6%) developed an increase in their donor common femoral artery acceleration time >133 msec and/or increased blood flow velocity without a simultaneous significant decrease in their recipient limb ABI. In the latter group the preoperative donor limb common femoral artery acceleration time and ABI and the immediate postoperative change in donor limb ABI were not significantly different (p>0.05) than in the remaining patients. These data suggest that there is a significant but transient decrease in donor limb ABI following FFBPG, that long-term changes in ABIs are symmetric in both limbs, and that inflow surveillance with duplex scanning and acceleration time measurement may allow early detection of hemodynamically significant inflow lesions prior to graft failure.Presented at the Seventeenth Annual Meeting of the Peripheral Vascular Surgery Society, Chicago, Ill., June 7, 1992.