Effect of the COVID-19 Pandemic on Infra-Inguinal Vein Bypass Graft Surveillance DUS Scans: Single Unit Experience

ABSTRACT

Introduction: Vein bypass graft surveillance has been a controversy in the literature. The pros are that it allows early detecting of graft complications and intervention;however, the cons are its time and cost burden, without significant benefit. The established practice in our unit is to offer duplex ultrasound (DUS) scan for patients who had infra-inguinal bypass surgeries using autogenous veins for the first two years. Scans should be done at six weeks, three months, six months, one year, and two year intervals. Our aim was to compare graft surveillance scan practice during the COVID-19 pandemic to practice in previous years. Methods and data collection We collected the data from electronic patients records completed by the unit for two years on 2016 – 2017 and from March 2020 until the end of February 2021. Patients who are scheduled for scans but have not yet reached the scan date were counted in the non-applicable group. We included only the first six months of graft surveillance. Results: Thirty-four patients had bypass at this time;four patients were excluded as two of them had predischarge occlusion, one was done using synthetic graft, and a patient passed away after discharge. The six week scan compliance was as follows 17 scans were successfully done;11 scans were not done;and five patients were non-applicable. The three month scan compliance was as follows 11 scans were successfully done, 17 scans were not done, and five scans were non-applicable. The six month scan compliance was distributed as follows one scan was done;19 scans were not done;and 12 scans were non-applicable. Graft surveillance compliance percentages between 2016 and 2017 to the COVID-19 pandemic year (March 2020 – March 2021) were as follows six week scan compliance was 86% – 60%;three month scan compliance was 79% – 42%;and six month compliance was 76% – 39%. Six interventions were offered to bypass patients based on the findings of DUS graft surveillance five patients had graft angioplasty and one had graft thrombolysis. A predischarge surveillance scan was done for 12 patients, representing 36% of the total number of patients. The findings detected three patent grafts, one graft had mild stenosis, five grafts had moderate stenosis, one graft had severe stenosis, and two grafts had complete occlusion. Conclusion and recommendations: The COVID-19 pandemic has negatively affected the number of graft surveillance scans. A predischarge graft surveillance scan was found useful as it detected significant findings that could be missed upon discharge. Therefore, when there are constraints on getting surveillance scans during the COVID-19 pandemic, it is reasonable to do predischarge scans to identify patients who would be at a higher risk of developing graft complications. [Formula presented]