Prognostic indicators in femoropopliteal reconstructions.

The incidence of early failure in 115 vein femoropopliteal grafts has been analyzed for the presence of reliable prognostic indicators of such failures. One hundred twelve patients had preoperative Doppler ultrasound assessment; 98 had intraoperative graft flow measured. Early graft failure was more prevalent in patients with rest pain and gangrene and in patients with poor runoff. Neither of these two findings had predictive value. Ninety-one percent of patients with a pressure index (ankle systolic pressure/brachial systolic pressure) less than 0.20 had early graft thrombosis. This suggests that arterial reconstruction is futile in this group. Measurement of vein graft flows intraoperatively was of value. Grafts with basal flows less than 70 ml/min uniformly thrombosed. There was significant correlation between ankle pressure index and intraoperative vein graft flow (r=.52). Both ankle pressure index and intraoperative vein graft flow provide prognostic indications of graft failure and should be of value in selecting patients for femoropopliteal reconstructions.