Question

A 55-year-old male underwent a common femoral artery to below knee popliteal artery bypass using reversed great saphenous vein graft one month ago.
How will you follow him up?

Hint:

Regular follow-up after bypass surgery is crucial for early detection of graft issues. Non-invasive imaging techniques like Color Doppler are essential for monitoring graft patency.

Answer 1

Step 1: Understanding the case.
The patient has undergone bypass surgery using a reversed great saphenous vein graft, which is a common approach for revascularizing the lower extremity in cases of peripheral arterial disease. Follow-up is essential to monitor for complications such as graft occlusion or stenosis.

Step 2: Follow-up plan.
Follow-up should include both clinical and imaging assessments:
1. Clinical examination: Monitor for symptoms such as claudication, rest pain, or signs of graft infection. Check for any signs of limb ischemia, such as changes in skin color, temperature, or pulses.
2. Ankle-brachial index (ABI): ABI should be measured to assess the graft's patency and the overall vascular status of the lower limb.
3. Color Doppler ultrasound: This non-invasive imaging technique can assess the patency of the graft, measure the peak systolic velocity (PSV) and evaluate for any stenosis or graft failure. Regular Doppler assessments are crucial in detecting early graft issues.

Step 3: Conclusion.
Follow-up should include clinical evaluation, ABI measurement, and regular imaging (e.g., Color Doppler ultrasound) to monitor graft patency and detect any complications.