Evaluation of proposed standards for runoff in femoropopliteal arterial reconstructions: correlation between runoff score and flow waveform pattern. A preliminary report.

The Ad Hoc Committee on Reporting Standards of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery (SVS/ISCVS) proposed a new angiographic scoring system that grades the quality of vessels distal to the expected bypass site and calculates an overall runoff score. To assess the predictability of the bypass grafts by this runoff scoring system, we compared this runoff score with postoperative increase in the ankle/brachial index (delta ABI) and intraoperatively measured flow waveform patterns in 60 patients undergoing femoropopliteal bypass grafts. No correlation was found between delta ABI and the runoff score. Graft-patent survival time correlated with the runoff score (r = 0.44, p = 0.02). Grafts with type 0 or I flow waveform pattern with a satisfactory long-term patency had a significantly lower runoff score than grafts with type II, III or IV flow waveform pattern (p less than 0.05). When all the grafts were arbitrarily divided into two groups (grafts with a runoff score over 4.5 and those with a score of less than 4.0), a superior long-term patency was obtained in the low runoff score group with polytetrafluoroethylene (p less than 0.01) and saphenous vein grafts (p = 0.04), but not in the group with composite grafts (p = 0.25). Thus, the SVS/ISCVS runoff scoring system can be used to predict the fate of bypass grafts in femoropopliteal arterial reconstructions.