Estenoses no enxerto de veia safena magna reversa em revascularizações arteriais infrainguinais

Abstract

Objective: The aim of this study was to evaluate the prevalence ofhemodynamically significant infrainguinal bypasses stenosis, which were performed with reverse great saphenous vein graft. These stenosis were detected using vascular ultrasonography on the 30th post-operative day. Methods: From March of 2008 to March of 2009, 56 infrainguinal bypasses were performed with reverse great saphenous vein graft in 56 patients. On the 30th post-operative day, 32 (21 men 61.6%) out of 56 patients were subjected to a vascular ultrasonography. The prevalence of significant graft stenosis was determined. In addition the diagnosis of stenosis were related to the clinical and surgical characteristics of the patients. The following variables were analyzed at the moment of stenosis diagnosis. First, the localization of the graft stenosis. Second,the risk factors associated with stenosis. Finally, the correlation between the vascular ultrasonography findings and the ankle-brachial pressure index. Results: The overall prevalence of significant graft stenosis was 48.4%. Out of the total number of observed stenosis, 19.4% were considered severe, and 29% mild or moderate. Considering the site of the stenosis, 35.7% of them were in the proximal anatomosis, 21,4% in the proximal third of the graft, 28,6% in the second third, and 14,3% in the distal anastomosis. There was no significant association between the presence of significant stenosis and the following variables: gender,diabetes, hypertension, smoking, hipercholesterolemia, graft diameter, site of the distal anastomosis, and graft composition. The agreement between ABI and the vascular ultrasonography in the diagnosis of stenosis were assessed using kappa test. There was a fair agreement between these two methods in detecting stenosis in general (K=0,30; IC95% 0,232 - 0,473; p=0,018). However, there was a substantial agreement in detecting severe stenosis (K=0,75; IC95% 0,655 - 0,811;p=0,0001). Conclusion: There was a high prevalence of stenosis on the 30th postoperative day, which were localized mainly in the first half of the vein graft. There was no significant association of the presence of stenosis with clinical and surgical factors analyzed. ABI and vascular ultrasonography had fair agreement for the diagnosis of stenosis in general and a substantial agreement for the diagnosis of severe stenosis.