Doppler Ultrasound in the Surveillance of a Femoro-Popliteal Bypass Graft and Associated Pseudoaneurysm
Ellen Cronin, Radiology Department, Mercy University Hospital, Grenville Place, Cork, Ireland
Background:
Bypass graft pseudoaneuryms are a delayed complication of surgery, usually located at anastomosis level. This case study demonstrates the role of Doppler ultrasound in the surveillance of a left femoro-popliteal autologous vein bypass graft, with subsequent pseudoaneurysm formation at mid graft level.
Ultrasound Findings:
7 years after initial surgery, Doppler ultrasound demonstrated a 3 cm x 3 cm pseudoaneurysm arising from the mid portion of the graft. 9 months later, the patient returned for further imaging. Doppler ultrasound revealed that the pseudoaneurysm had increased in size to 4.7 cm in maximal dimension. Consequently, the patient underwent surgery to excise the pseudoaneurysm. 10 days later, Doppler ultrasound was again performed due to a swelling in the patients mid thigh. This corresponded to a 4.7 cm x 5.7 cm hypoechoic avascular abnormality surrounding the bypass graft, consistent with a haematoma.
Discussion:
Peripheral arterial disease is an increasing entity worldwide and advanced disease results in a decline in ambulatory functions and reduced quality of life. In the management of the disease, revascularisation of the limb plays a critical role. In the post-operative setting, a successful Doppler ultrasound graft surveillance program will prolong graft patency. An example of which includes a Doppler ultrasound at 1, 3, 6 and 12 months and 6 months thereafter. Unfortunately for the patient at the centre of this case study, a CT angiogram 2 months post surgery revealed an occluded femoro-popliteal bypass graft throughout its length. Subsequently, the femoro-popliteal bypass graft was revised with a synthetic interposition graft.
Conclusion:
Doppler ultrasound plays an essential role in both the surveillance of femoro-popliteal autologous vein bypass grafts and identification of subsequent complications. As a result, a Doppler ultrasound surveillance program should be implemented for all patients undergoing femoro-popliteal bypass surgery.