Outcomes of completion imaging for lower extremity bypass in the Vascular Quality Initiative

Abstract

Objective: The objective of this study was to determine the association of intraoperative completion imaging (CI) for lower extremity vein bypass to a below-knee target with primary patency in the Vascular Quality Initiative.

Methods: The Vascular Quality Initiative database was queried from January 2003 to October 2013 for lower extremity bypass (LEB) procedures that were elective, had an indication of occlusive disease, used a single-segment greater saphenous vein conduit, and had a below-knee target. LEBs with inflow arteries above the knee and below the knee were included. LEBs with concomitant endovascular procedures were excluded. CI was defined as completion angiography, completion duplex ultrasound, or both. The end points were primary patency at discharge and at 1 year. Multivariable analysis was performed controlling for patient demographics, comorbidities, bypass characteristics, and center.

Results: Of 14,284 LEBs that were performed during the study period, 3147 satisfied the inclusion and exclusion criteria. Of 1457 (46%) that underwent CI, 287 (20%) underwent duplex ultrasound, 1116 (77%) underwent angiography, and 54 (3.7%) underwent both duplex ultrasound and angiography. There were more patients in the CI group with a history of smoking and a bypass graft crossing the knee. There was no difference in primary patency at discharge between the two groups (CI, 93.2% vs no CI, 93.8%; P = .52). Of the patients who underwent CI, the discharge primary patency was 95.1% for completion duplex ultrasound vs 92.8% for completion angiography (P = .17). On multivariable analysis, there was no significant association of CI with discharge primary patency (P = .69). The 1-year primary patency was 63% in the CI group vs 68% in the no CI group (P = .051). The 1-year primary patency was 60% for the duplex ultrasound group vs 65% for the angiography group (P = .61). On multivariable analysis, there was no significant association of CI with 1-year primary patency (P = .69).

Conclusions: In electively performed LEBs using single-segment saphenous vein to a below-knee target artery for occlusive disease, CI does not influence primary graft patency at discharge or at 1 year.