Colour flow imaging in the detection of femoro-distal graft and native artery stenosis: Improved criteria

Vein graft or native artery stenosis after femoro-distal revascularisation is a common cause of graft occlusion. The early detection and treatment of such stenoses offers the potential for better graft patency than salvage procedures undertaken for graft thrombosis. In the past, two criteria using duplex scanning have been used to detect grafts at risk: (a) a localised increase in the peak velocity (V2) by 100% or more in comparison to the peak velocity (V1) 2 cm upstream (i.e. V2/V1 ratio greater than 2.0), and (b) a decrease in average peak velocity to less than 45 cm s-1. Seventy-four consecutive patients with femoro-distal vein grafts have been studied with intravenous digital subtraction angiography to detect stenosis (greater than 50% diameter) and colour flow imaging using both duplex scanning criteria (a) and (b) at 1.5, 3, 6, 9 and 12 months after operation. The results show that the V2:V1 ratio greater than criterion had a sensitivity of 100% and a specificity of 83%. Stenoses in the native distal arteries were not detected. Low average peak velocity less than 45 cm s-1 had a sensitivity of 61% and a specificity of 98%. By combining both criteria the sensitivity for detecting stenoses in both the vein graft and native distal artery, became 100% and the specificity 98%.