The clinical importance and prediction of steal following femoro-femoral cross-over bypass: study of the donor iliac artery by intravascular ultrasound, arteriography, duplex scanning and pressure measurements.

OBJECTIVES: to evaluate the clinical significance of the steal phenomenon following femoro-femoral bypass, and whether the addition of intravascular ultrasound (IVUS) to the established examinations of the donor iliac artery can improve the prediction of patients who will develop steal. DESIGN: prospective study. MATERIAL AND METHODS: twenty-eight patients, aged 73 (50-81) years, scheduled for femoro-femoral bypass surgery in the period from 1994 to 1997, had the donor iliac artery examined by single-plane arteriography, duplex scanning, IVUS and femoral-artery blood pressure measurements (FABP)+/-papaverine. Three patients were excluded due to simultaneous thromboendarterectomy (TEA) of the donor iliac artery. The clinical stage and the ankle-brachial index (ABPI) were measured pre-, postoperatively and prospectively 1, 6, 12 and 24 months after discharge. RESULTS: two patients developed clinical steal, while an additional five had a measurable (>0.1) decline in the donor ABPI postoperatively, but no symptoms (subclinical steal). The clinical stage of the donor limb did not deteriorate further during the follow-up period (median 8 months) in these seven patients. The decline in donor ABPI correlated with the FABP and the IVUS measurements, but not to duplex scanning or arteriography. FABP after papaverine injection and IVUS examination showed equal sensitivities and and specificities. CONCLUSION: a clinical steal phenomenon following femoro-femoral bypass surgery seems relatively uncommon, although a subclinical steal is more frequent. Both can be predicted by FABP or IVUS. Further follow-up is required to evaluate whether subclinical steal has any consequences in the long term.