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     Kelly, I assume she had no significant inflow disease to cause the
     monophasic flow. This sounds like hyperemia. If this was 1 day post op
     I would say not to worry. But at three months, you have to think some
     sort of inflamatory thing, most likely infection, which can cause the
     hyperemic flow. Lymphedema is also a possibility. Did you note any
     seroma or anything else unusual surrounding the graft?

     Bill Schroedter


______________________________ Reply Separator _________________________________
Subject: Infrainguinal Bypass Graft Surveillance
Author:  UVM Flownet <[log in to unmask]> at Internet
Date:    12/15/98 9:09 PM


To all:
        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