gms | German Medical Science

Background: Infra-inguinal bypass graft failure within the first two postoperative years can result from stenotic lesions within the conduit and near the anastomosis [1]. Despite limited prospective data, the Global Vascular Guidelines (2019) recommends regular clinical assessment and duplex ultrasound (DUS) [1]. NICE guidance (2020) recommends offering high-intensity statin and antiplatelet therapy to patients post-revascularisation [2]. This study aims to assess the graft surveillance uptake, patency, amputation and death rates among infra-inguinal bypass surgery patients at 1, 6 and 12 months postoperatively.

Methods: Patients undergoing infra-inguinal bypass at a single vascular centre between 1^st January 2018 and 31^st December 2019 were identified from the prospectively collected database and Caldicott-approved data collection was performed with 1 year follow-up as per local protocol. The primary outcomes at 1, 6 and 12 months postoperatively included: graft DUS surveillance uptake, patency, major amputations and death rates. Statins, LDL Cholesterol (LDL-C) levels and antiplatelet therapy were recorded at time of operation (baseline) and 1 year post-operatively. Statistical analysis with SPSS^® was performed using chi-squared tests and paired sample t-tests to compare means (p<0.05 defined as significant).

Results: Of the 91 patients included in this study, 79.1% were men and median age was 71 years (IQR 62-76). Femoral-popliteal bypass was the most commonly performed infra-inguinal bypass (61.5%). At 1, 6 and 12 months, DUS surveillance uptake was 74.2%, 77.5% and 73.3% respectively while primary-assisted patency rates were 88.2%, 78.8% and 65.3% respectively and secondary patency rates were 97.6%, 96.3% and 96.3% respectively. Major amputation rates at 1, 6 and 12 months were 5.4%, 8.6%, 8.6% respectively. Death rates at 1, 6 and 12 months were 3.2%, 5.4% and 10.8% respectively. Proportion of patients on high-intensity statin increased from 71.4% at baseline to 77.9% at 1 year (p<0.001). Mean (SD) LDL-C level remained unchanged at baseline and 1 year at 1.75 (0.86) mmol (p=0.929). Patients on statin therapy post-operatively had lower 12-month mortality compared to those not on statin therapy (7.7% vs 30.0%, p=.028). Major amputation rate at 12 months was lower among patients prescribed antiplatelet therapy immediately post-operatively (6.3% vs 40%, p=.008) with effect maintained at 1 year (5.8% vs 28.6% p=.033).

Table 1 [Tab. 1], Figure 1 [Fig. 1]

Conclusion: DUS graft surveillance programmes can represent a vital opportunity to adequately optimise statin and antiplatelet therapy post-revascularisation in order to reduce the 12-month major amputation and mortality rates.