Yield of Graft Surveillance after Open Aortic Operations

Background To examine the value of routine postoperative surveillance duplex in identifying late graft-related complications after open aortic operations for occlusive and aneurysmal disease. Methods All open aortic operations performed at a single institution between 1998 and 2012 were retrospectively reviewed. All patients were scheduled for yearly postoperative surveillance duplex. Patients who had at least 30-day follow-up and at least 1 surveillance duplex were analyzed. Results Two hundred thirty-eight open aortic operations were performed during the study period, 140 of which met the inclusion criteria. Mean follow-up was 3.9 years. A tube graft was performed in 65 (46%), and the proximal anastomosis was in the infrarenal or juxtarenal position in 126 (90%). Overall survival at was 100% and 85.3% at 1 and 5 years, respectively. A mean of three surveillance duplexes was performed per patient. Surveillance duplex scanning identified 31 significant findings in 31 patients, including 13 significant velocity increases (>3:1) and 18 aneurysms/pseudoaneurysms. Thirteen (9%) patients required a graft-related operation at a mean of 3.5 years. Indications included anastomotic aneurysm/pseudoaneurysm (n = 7), limb occlusion (n = 3), graft stenosis (n = 2), and graft infection (n = 1). The indication for operation was identified by surveillance duplex in 5 of the 13 cases. The remainder were identified by physical examination and/or clinical presentation. Reintervention-free survival (RIFS) was 98.5% at 1 year and 80.4% at 5 years. On multivariable analysis, RIFS was improved only by the use of a tube graft during the index operation (hazard ratio, 0.73; 95% confidence interval, 0.54-0.96). Conclusions Routine surveillance duplex identifies few findings that lead to reintervention. Patients with a non-tube-graft reconstruction are at greater risk for reintervention and may benefit from surveillance duplex after open aortic operations.