I would like to pose a question about infrainguinal bypass grafts.. I had a
patient recently who came in 3 months post op right fem pop (above knee)
gortex graft. Her main complaint was lower leg edema and red toes. Her
subjective complaints of her foot were that it was hot and was itchy/burning.
I performed a bilateral venous study before proceeding to the arterial exam.
The venous study was normal bilaterally. Her resting ABI's were 1.01
bilaterally, and her toe/brachial indices were .74 and .70 respectively with
normal waveforms. The graft velocities were as follows:
1. Inflow vessel 170 cm/s monophasic
2. proximal anastomosis 270cm/s monophasic - color flow was slightly aliased
with widely patent graft.
3. prox graft 70cm/s monophasic
4. mid graft 48 cm/s monophasic
5. distal graft 78 cm/s monophasic
6. distal anastomosis 120 cm/s monophasic
7. outflow artery 90 cm/s monophasic
8. PTA 38 cm/s monophasic
With the graft being widely patent and the patient experiencing no
claudication symptoms and a hot tingling foot, with normal ABI and toe
indices, what sort of diagnosis would you come up with?
The other extremity waveforms were triphasic and she is 3 months post op....
P.S. The patient is not diabetic and her previous ABI's were .49 and 1.05.
Kelly Estes RDMS, RDCS, RVT