Utilization Of Preoperative Vein Mapping In Patients Undergoing Infra-inguinal Bypass Is Associated With Increased Use Of Venous Conduits
Abdul Kader Natour, MD1, Peter Henke, MD2, Alexander Shepard, MD1, Robert Cuff, MD3, Nick Mouawad, MD4, Mark Mattos, MD5, Timothy Nypaver, MD1, Loay Kabbani, MD1.
1Henry Ford Health System, Detroit, MI, USA, 2University of Michigan Hospital, Ann Arbor, MI, USA, 3Spectrum Health Butterworth Hospital, Grand Rapids, MI, USA, 4McLaren Health Care System, Bay City, MI, USA, 5McLaren Health Care System, Flint, MI, USA.
Objective: To determine if preoperative vein mapping (PVM) was associated with increased use of autogenous venous conduits in a real-world registry of lower extremity infra-inguinal bypass (IIB). Methods: A retrospective review of a statewide vascular surgery registry was queried for all patients between 2012 and 2020 who underwent IIB. We excluded trauma patients and patients with acute limb ischemia, and previous lower extremity bypasses. Preoperative, and intraoperative variables were analyzed, and post-operative outcomes were correlated with the use of PVM. Results: A total of 5540 patients were included in the study. The average age was 67 years. Sixty-nine percent of the cohort were male, and 81% were white. PVM was performed on 2532 patients (45%). Patients who underwent PVM were more likely to be white, diabetic, have commercial insurance, and presented with more chronic limb-threatening ischemia and lower ankle-brachial indices. Patients who did not undergo PVM were more likely to be current smokers and have a history of COPD. A venous conduit was significantly more likely to be used in patients who underwent pre-op vein mapping (69% vs 28%, P<0.001). When looking at patients who underwent IIB with a venous conduit; Intra-operative blood loss was significantly less and 30-day transfusion tended to be lower in patients who had PVM (290mL vs 323mL, P=0.032; 30% vs 26%, P=0.07), although no significant difference was seen with the length of procedure (P=0.44). Intraoperative angiogram/duplex ultrasonography to establish technical adequacy was more commonly used in the PVM subgroup (39% vs 32% P<0.001) and was more likely to be reported as normal. No significant difference was found in terms of short-term outcomes (LOS, neurologic, renal or cardiac complications, 30-day patency, readmission, and death) or for SSI variables (30-day readmission or return to OR for wound infection). Conclusions: Most patients do not have PVM before their IIB. Patients who undergo PVM are more than twice as likely to have a venous conduit used for their bypass. In patients who underwent autogenous venous conduit bypass, post-operative imaging to establish technical adequacy was performed more frequently in patients who underwent PVM and was more likely to be reported as normal. Despite no change in 30-day or 1-year patency, PVM may be a marker for physicians who are interested in best practices for IIB.
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