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Clinical Research|Articles in Press

Routine Completion Angiography For Infrainguinal Bypasses Using Prosthetic Conduit: No Effect On Postoperative Patency

Published:March 09, 2023DOI:https://doi.org/10.1016/j.avsg.2023.02.036

      Abstract:

      Introduction

      Recent studies have demonstrated increased postoperative patency with the use of routine completion angiography for bypass using venous conduit. Compared to vein conduits however, prosthetic conduits are less plagued by technical issues such as unlysed valves or arteriovenous fistulae. The effect of routine completion angiography on bypass patency in prosthetic bypasses has yet to be compared to the more traditional selective use of completion imaging.

      Methods

      A retrospective review of all infrainguinal bypass procedures using prosthetic conduit completed at a single hospital system from 2001 to 2018 was performed. Demographics, comorbidities, intraoperative reintervention rates and 30-day rates of graft thrombosis were analyzed. Statistical analysis included t-tests, chi square tests and cox regression.

      Results

      Four hundred and ninety-eight bypasses that were performed in 426 patients met inclusion criteria. Fifty-six (11.2%) bypasses were classified into the routine completion angiogram group compared to 442 (88.8%) into the no completion angiogram group. Patients who underwent routine completion angiograms had a rate of intraoperative reintervention of 21.4%. When comparing bypasses that underwent routine completion angiography versus no completion angiography, there were no significant differences in rates of reintervention (3.5% vs. 4.5%, P=0.74) or graft occlusion (3.5% vs. 4.7%, P=0.69) at 30-days postoperatively.

      Conclusion

      Almost one-quarter of lower extremity bypasses using prosthetic conduit that undergo routine completion angiography undergo post-angiogram bypass revision, however this is not associated with an increased graft patency at 30-days postoperatively.
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      References

        • Bandyk DF
        • Mills JL
        • Gahtan V
        • et al.
        Intraoperative duplex scanning of arterial reconstructions: fate of repaired and unrepaired defects.
        J Vasc Surg. 1994; 20 (discussion 432-3): 426-432
        • Mills JL
        • Fujitani RM
        • Taylor SM
        Contribution of routine intraoperative completion arteriography to early infrainguinal bypass patency.
        Am J Surg. 1992; 164 (discussion 510-1): 506-510
        • Dalman RL
        • Harris EJ
        • Zarins CK
        Is completion arteriography mandatory after reversed-vein bypass grafting?.
        J Vasc Surg. 1996; 23: 637-644
        • Marin ML
        • Veith FJ
        • Panetta TF
        • et al.
        A new look at intraoperative completion arteriography: classification and management strategies for intraluminal defects.
        Am J Surg. 1993; 166 (discussion 139-40): 136-139
        • Tan TW
        • Rybin D
        • Kalish JA
        • et al.
        Routine use of completion imaging after infrainguinal bypass is not associated with higher bypass graft patency.
        J Vasc Surg. 2014; 60: 678-685 e2
        • Png CYM
        • Kim Y
        • Jessula S
        • et al.
        Reassuring Intraoperative Parameters Do Not Obviate the Need for Infrainguinal Bypass Completion Angiograms.
        Ann Surg. 2021;
        • Tolegenuly A
        • Ordiene R
        • Jakuska P
        • et al.
        Intraoperative angiography during coronary artery bypass grafting.
        Perfusion. 2022; 37: 394-401
        • Zhao DX
        • Leacche M
        • Balaguer JM
        • et al.
        Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room.
        J Am Coll Cardiol. 2009; 53: 232-241
        • Johnson BL
        • Bandyk DF
        • Back MR
        • et al.
        Intraoperative duplex monitoring of infrainguinal vein bypass procedures.
        J Vasc Surg. 2000; 31: 678-690
        • Andreucci M
        • Solomon R
        • Tasanarong A
        Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention.
        Biomed Res Int. 2014; 2014741018