In vascular grafts, which graft abnormality most commonly requires correction?

• A. Arterial graft occlusion
• B. Graft infection
• C. Vein conduit stenosis
• D. Anastomotic pseudoaneurysm

Answer: (C)

Vein conduit stenosis is the abnormality most often requiring correction in vascular grafts. Vein grafts commonly develop neointimal hyperplasia that causes narrowing at the graft–artery anastomosis or within the mid portion of the graft. This focal narrowing reduces flow, can lead to decreased graft patency and symptoms, and is typically detectable on surveillance with duplex ultrasound or graft waveform changes. Because this narrowing directly impairs graft function and is amenable to restoration of flow, it is the lesion most frequently treated, usually with endovascular angioplasty (sometimes with stenting) or, if needed, surgical revision.

Graft infection tends to be a more dire complication but occurs less frequently and requires different management, often including graft removal. An occluded graft is a serious problem but often represents progression from a stenotic lesion; the correction pathway is less routinely pursued than for a straightforward stenosis identified at surveillance. Pseudoaneurysm at the anastomosis is less common and typically requires surgical repair.