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 PS96. Routine Compared to Selective Use of Completion Imaging After Infrainguinal Lower Extremity Bypass is Not Associated with Higher Bypass Graft Patency

​Tze-Woei Tan1, Jeffrey Kalish1, Naomi M. Hamburg1, Andres Schanzer2, Robert Eberhardt1, Denis Rybin1, Gheorghe Doros1, Jack L. Cronenwett3, Alik Farber1, For the Vascular Surgery Group of New England
1Boston Medical Center/Boston University School of Medicine and Public Health, Boston, MA; 2UMass Memorial Medical Center, Boston, MA; 3Dartmouth-Hitchcock Medical Center, Lebanon, NH.

OBJECTIVES: Significant variability exists in completion imaging (CIM) use after infrainguinal lower extremity bypass (LEB). Although selective use of CIM has clear indications, routine use remains controversial. We evaluated 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 and/or duplex) among patients undergoing LEB. Surgeon-specific CIM strategy was categorized as selective (<80% of LEB) vs. routine (≥80% of LEB). Exclusion criteria were acute limb ischemia, bilateral procedures, and surgeon volume <10cases/study period. Primary graft patency at discharge and 1-year were analyzed based on CIM utilization 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%). Dialysis (OR 1.7, 95% CI1.12-2.59, p=0.01), elective LEB (OR 3.99,95%CI1.2-13.1, p=0.02), great saphenous vein conduit (OR2.0,95% CI1.6-2.5,  p<0.0001), and tibial/pedal target (OR1.8, 95%CI1.4-2.3,p<0.0001) were associated with CIM use. In multivariate models CIM was not associated with improved graft patency at discharge (OR 1.1, 95% CI:0.7-1.7, p=0.64) or 1-year (OR 1.0,95% CI:0.8-1.4, p=0.88).
Sixteen surgeons (33%) were routine and 32(67%) were selective CIM users. Discharge and 1-year graft patency was 96% vs. 94% (p=0.21) and 68% vs. 72% (p=0.09) in patients of routine vs. selective CIM users. In multivariate analysis, routine or selective CIM strategy was not associated with improved discharge (OR 0.8; 95% CI:0.6-1.1; p=0.3) or 1-year (OR 1.1; 95%CI:0.9-1.2; p=0.56) graft patency.

CONCLUSIONS: In our observational cohort, surgeon-specific strategy of selective CIM after LEB has comparable outcomes with routine CIM. Use of selective rather than routine CIM may lead to decreased health care resource utilization.

AUTHOR DISCLOSURES: J. L. Cronenwett, Nothing to disclose; G. Doros, Nothing to disclose; R. Eberhardt, Nothing to disclose; A. Farber, Nothing to disclose; N. M. Hamburg, Nothing to disclose; J. Kalish, Nothing to disclose; D. Rybin, Nothing to disclose; A. Schanzer, Nothing to disclose; T. Tan, Nothing to disclose.

Posted April 2012

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