Routine use of completion imaging after infrainguinal bypass is not associated with higher bypass graft patency
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Authors
Tan, Tze-WoeiRybin, Denis
Kalish, Jeffrey A.
Doros, Gheorghe
Hamburg, Naomi
Schanzer, Andres
Cronenwett, Jack L.
Farber, Alik
UMass Chan Affiliations
Department of Surgery, Division of Vascular and Endovascular SurgeryDocument Type
Journal ArticlePublication Date
2014-09-01Keywords
AgedAged, 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
Metadata
Show full item recordAbstract
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.Source
J Vasc Surg. 2014 Sep;60(3):678-85.e2. doi: 10.1016/j.jvs.2014.03.004. Link to article on publisher's siteDOI
10.1016/j.jvs.2014.03.004Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49719PubMed ID
24721174Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.jvs.2014.03.004