Noninvasive Diagnosis of Vascular Disease by Falls B. Hershey, Robert W. Barnes and David S. Sumner

By Falls B. Hershey, Robert W. Barnes and David S. Sumner (Eds.)

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13 Frequent noninvasive testing can detect correctable lesions in some of these patients. Indeed, clinical evaluation is not sufficient in cases of early lesions. Thrombosis sometimes occurs without any previous claudication, particularly in patients whose activity is limited by disease of the other leg or by cardiopulmonary disease. Such limitations restrict exercise and, of course, claudication. Even when claudication suggests the need for an arteriogram, the vascular laboratory's confirmation is reassuring.

7 In Berkowitz's series, 27 of 30 grafts harboring vein-graft stenosis were initially treated by PTA. Four of these vein grafts became occluded, and five additional grafts developed restenosis after having been successfully dilated. This experience represents a 33% failure rate for PTA. We prefer to replace the diseased segment with a new healthy living sleeve of vein inserted end-to-end with interrupted sutures. The stenoses we treated were easily accessible because of the subcutaneous graft bed utilized in our series.

In Hemodynamics of the Limbs—1. Edited by P Puel, H Boccalon, A Enjalbert. Toulouse, France, GEPESC, 1979, pp 543-546. 22. Sumner DS : Defining the need for and assessing the results of tibial-peroneal-dorsalis pedis bypass grafts by non-invasive tests. In Hemodynamics of the Limbs—2. Edited by P Puel, H Boccalon, A Enjalbert. Toulouse, France, GEPESC, 1981, pp 425-433. 42 CHAPTER 4 POSTOPERATIVE NONINVASIVE EVALUATION ÖFFEMOROTIBIAL BYPASS GRAFTS Joseph J. 1-4 Regrettably, the first sign or symptom of graft failure may be catastrophic, complete thrombosis, and successful restoration of flow usually requires replacement of the entire vein graft.

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