Identification of vein graft stenosis and assessment of sustainability of outcomes: Two sides of the same coin in vein graft surveillance

Autologous veins are the conduit of choice when performing an infra-inguinal arterial bypass procedure. However these grafts are at risk of failure. This is multifactorial in nature and relates to patient factors, factors relating to the procedure as well as adaptive processes which occur after the formation of an infrainguinal bypass graft. Duplex ultrasound assessment of haemodynamic findings within the graft is the most accurate method of identifying vein graft stenosis and identifying grafts which are at risk of failure. Duplex ultrasound examination findings together with clinical factors can be used to individualise vein graft surveillance. This review examines the steps involved in a successful vein graft surveillance program, how to optimise the cost utility of vein graft surveillance by identifying the grafts which are at highest risk of failure and how there has been a paradigm shift away from surgical revision and towards endovascular revision of failing infrainguinal grafts.