Routine use of completion imaging after infrainguinal bypass is not associated with higher bypass graft patency
Department of Surgery, Division of Vascular and Endovascular Surgery
Medical Subject Headings
Aged; Aged, 80 and over; Blood Vessel Prosthesis Implantation; Chi-Square Distribution; *Diagnostic Imaging; Female; Graft Occlusion, Vascular; control; Humans; Ischemia; Kaplan-Meier Estimate; Lower Extremity; Male; Middle Aged; Multivariate Analysis; New England; Odds Ratio; Peripheral Arterial Disease; Predictive Value of Tests; Proportional Hazards Models; Registries; Risk Factors; Saphenous Vein; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; *Vascular Patency
Cardiovascular Diseases | Surgery
BACKGROUND: Significant variability exists in completion imaging (CIM) after infrainguinal lower extremity bypass (LEB). We evaluated the use of CIM and compared graft patency in patients treated by surgeons who performed routine CIM vs those who performed selective CIM.
METHODS: We reviewed the Vascular Study Group of New England database (2003-2010) and assessed the use of CIM (angiography or duplex ultrasound) among patients undergoing LEB. The surgeon-specific CIM strategy was categorized as routine ( > / = 80% of LEBs) vs selective ( < 80% of LEBs). Exclusion criteria included acute limb ischemia, bilateral procedures, and surgeon volume < 10 cases per study period. Primary graft patency at discharge and at 1 year was analyzed on the basis of CIM use and surgeon-specific CIM strategy. Multivariable analyses were performed using Poisson regression.
RESULTS: Among 2032 LEB procedures performed by 48 surgeons, CIM was used in 1368 cases (67.3%). CIM was performed in 72% of autogenous LEBs and 52% of prosthetic grafts. Dialysis (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.6; P = .01), elective LEB (OR, 2.6; 95% CI, 1.4-4.8; P = .002), great saphenous vein conduit (OR, 2.0; 95% CI, 1.6-2.5; P < .001), and tibial or pedal target artery (OR, 1.8; 95% CI, 1.4-2.3; P < .001) were associated with CIM use. In multivariate models, CIM was not associated with improved primary graft patency at discharge (OR, 1.1; 95% CI, 0.7-1.7; P = .64) or at 1 year (OR, 0.9; 95% CI, 0.7-1.2; P = .47). Sixteen surgeons (33%) were routine users and 32 (67%) were selective users of CIM. Among patients of routine vs selective CIM users, primary graft patency at discharge and at 1 year was 96% vs 94% (P = .21) and 68% vs 72% (P = .09), respectively. In multivariate analysis, routine or selective CIM strategy was not associated with improved discharge (rate ratio, 0.8; 95% CI, 0.6-1.1; P = .31) or 1-year (rate ratio, 1.1; 95% CI, 0.9-1.2; P = .56) graft patency.
CONCLUSIONS: In our observational cohort, CIM does not improve short-term and 1-year bypass graft patency in infrainguinal LEB. The surgeon-specific strategy of selective CIM after LEB has outcomes comparable to those of routine CIM. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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Citation: J Vasc Surg. 2014 Sep;60(3):678-85.e2. doi: 10.1016/j.jvs.2014.03.004. Link to article on publisher's site
Tan, Tze-Woei; Rybin, Denis; Kalish, Jeffrey A.; Doros, Gheorghe; Hamburg, Naomi; Schanzer, Andres; Cronenwett, Jack L.; and Farber, Alik, "Routine use of completion imaging after infrainguinal bypass is not associated with higher bypass graft patency" (2014). Surgery Publications and Presentations. 145.