Perioperative noninvasive hemodynamic ankle indices as predictors of infrainguinal graft patency

Of 129 femoropopliteal bypasses, 40 closed in 0 to 42 months. Early and late closures were not predicted by pre- or postoperative ankle/brachial pressure index (ABPI) or ankle pulse volume recording amplitude (APVR) or their increments (Δ). Of 141 femorotibial bypasses, 60 closed in 0 to 12 months, with 46 closing early (<1 month). Early failure occurred in 19 of 52 limbs (37%) with pre-ABPI <0.2 and 17 of 89 limbs (19%) with pre-ABPI >0.2 (p < 0.025). Similar significant differences in early patency occurred between limbs with pre-APVR <5 and >5 mm (29 of 94 [34%] vs. 7 of 47 [15%], respectively). Late closure was not predicted by either value. Thus in the 44 limbs with pre-ABPI >0.2 and pre-APVR >5 mm, only 11 grafts closed (25%), whereas if pre-ABPI was <0.2 or pre-APVR <5 mm, 49 of 97 grafts (51%) occluded within 17 months (p < 0.025). Postoperative or Δ indices had no predictive value. Preoperative ABPI <0.2 or APVR <5 mm was associated with twice the risk of early femorotibial graft closure; however, cumulative life-table patency was still 39% at 24 months.