At what peak velocity ratio value should duplex-detected infrainguinal vein graft stenoses be revised?

Objectives:To determine the peak velocity ratio (PVR) threshold at which to intervene and correct duplex detected vein graft stenoses.Design:Prospective study.Materials:Infrainguinal vein grafts in patients attending the vascular studies for routine postoperative surveillance.Methods:Colour duplex detected stenotic vein graft lesions with a peak velocity ratio (PVR) between 2.0 and 2.9 were identified and monitored by serial duplex scans performed monthly for 3 months and then at 3-monthly intervals thereafter. At the end of the study period, the outcome of these lesions were analysed.Results:Thirty-eight lesions were identified from 32 grafts. Of these lesions, sixteen (42%) resolved, 11 (29%) remained stable and 11 (29%) progressed to a PVR of ≥3.0 and underwent angioplasty. There were no occlusions in any of the grafts during the period of study.Conclusion:Colour duplex detected vein graft stenoses with a PVR of less than 3.0 can be treated expectantly if grafts with stenoses with a PVR 2.0–2.9 are scanned every month for at least 3 months after detection