Prospective Comparison of Intraoperative Angiography with Duplex Scanning in Evaluating Lower-Extremity Bypass Grafts in a Community Hospital

Abstract

The gold standard for intraoperative evaluation of lower-extremity bypass grafts has been angiography. Limitations of this technique include inability to measure flow dynamics, violation of graft integrity, cost, and length of assessment time. The goal of this study was to evaluate duplex scanning as an alternative modality for intraoperative graft assessment. Our study group comprised of 19 consecutive patients undergoing infrainguinal bypass procedures at our institution between March 1999 and March 2000. Intraoperative angiography was compared with duplex scanning by evaluating parameters of assessment time, graft flow velocities, serum creatinine levels, and 30-day graft patency rates. Mean study times were the following: cut-film angiography, 22 ± 1.8 minutes; real-time fluoroscopy, 17 ± 2.5 minutes; and duplex imaging, 10.4 ± 1.1 minutes. As noted duplex imaging times as compared with radiographic modalities were significantly shorter ( P < 0.05). There was a substantial cost difference between angiography ($650) and duplex scanning ($350). A100 per cent correlation of study findings was noted between angiography and duplex scanning. No significant change in pre- versus postoperative creatinine levels was found. We conclude that duplex scanning is an effective modality and provides reliable intraoperative vascular graft assessment data in a community hospital setting. Advantages include a shorter study time, lower cost, flow dynamic data acquisition, and avoidance of mechanical graft trauma.

Trust but Verify? Utility of Intraoperative Angiography After Revascularization for Vascular Trauma

“…Intraoperative angiography is both a sensitive and specific manner of detecting vascular abnormalities around a surgical repair and adds little time to an operation. 11 To the best of our knowledge, there has not been a study analyzing the outcomes of peripheral vascular trauma patients without a palpable distal pulse at the end of a vascular repair. We hypothesize that patients without a palpable pulse in the affected extremity are more likely to return to the operating room during their hospital admission if IA was not performed.…”

“…Intraoperative angiography is both a sensitive and specific manner of detecting vascular abnormalities around a surgical repair and adds little time to an operation. 11…”