Joseph Wuamett, Jordan R. Sasson, Jamie Schwartz, Michael Dudkiewicz, John C. Lantis
Vascular Surgery, St. Lukes - Roosevelt Hospital Center, University Hospital of Columbia University College of Physicians and Surgeons, New York, NY.
OBJECTIVES: While many vascular surgeons follow the algorithm of post-operative bypass vascular evaluation including non-invasive flow studies (NIFS) and bypass graft duplex (BGD) at 1, 3, 6 months and annually thereafter, the data surrounding this recommendation is low. It has been shown that routine BGD scanning following autogenous lower extremity bypass has not proven to be cost-effective. The TASC II document recommends a biannual assessment of exercise NIFS for 2 years post-operatively as Level C evidence. Superficial femoral artery (SFA) percutaneous transluminal angioplasty/stent (PTA/S) trials have required similar schedules of post-procedure evaluation. We chose to evaluate the benefit of post-procedure imaging.
METHODS: We undertook a retrospective review of a prospective database looking at SFA intervention. The number of follow up visits, frequency of changes in exam, changes in post-procedure NIFS and BGD were analyzed.
RESULTS: One hundred four patients had SFA interventions (46 PTA, 46 PTA/stent, 8 atherectomy, 4 PTA/lysis). Initial studies (NIFS and/or BGD) within 1-7 weeks showed a change (ABI <0.7 and/or 4:1 peak systolic velocity ratio) in 3.1% of cases, at 3 months an additional 41% showed change (RR >1.0; p<0.05); at 6 months only an additional 8% showed change (RR <1.0; p>0.05). Kaplan Meier analysis revealed a lack of significance at the 1 year mark and beyond due decreased follow up.
CONCLUSIONS: Of the 547 post-procedure perfusion assays performed in these 104 patients, the statistically significant interval appears to be at the 3 month post-procedure visit. While the initial study acts as a baseline the utility of further testing does not appear to add significant additional information on a cohort basis. Like algorithms for distal bypass there did appear to be better correlation when coupled with return of symptoms and or change in physical exam.
AUTHOR DISCLOSURES: M. Dudkiewicz: Nothing to disclose; J. C. Lantis: Nothing to disclose; J. R. Sasson: Nothing to disclose; J. Schwartz: Nothing to disclose; J. Wuamett: Nothing to disclose.
Posted April 2013