Systematic review and meta-analysis of duplex ultrasound surveillance for infrainguinal vein bypass grafts

Abd Moain Abu Dabrh, Khaled Mohammed, Wigdan Farah, Qusay Haydour, R. Eugene Zierler, Zhen Wang, Larry J. Prokop, Mohammad H Murad

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Objective Duplex ultrasound (DUS) surveillance of infrainguinal vein bypass grafts is widely practiced, but the evidence of its effectiveness compared with other methods of surveillance remains unclear. Methods Following an a priori protocol developed by the guidelines committee from the Society for Vascular Surgery, this systematic review and meta-analysis included randomized and nonrandomized comparative studies that enrolled patients who underwent infrainguinal arterial reconstruction and received DUS surveillance for follow-up compared with any other method of surveillance. The search included MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scopus through November 2016. Outcomes of interest included all-cause mortality, limb viability, and graft patency reports. Meta-analysis was performed using the random-effects model. Results We included 15 studies. Compared with ankle-brachial index and clinical examination, DUS surveillance was not associated with a significant change in primary, secondary, or assisted primary patency or mortality. DUS surveillance was associated with a nonstatistically significant reduction in amputation rate (odds ratio, 0.70 [95% confidence interval, 0.23-2.13]). The quality of evidence was low because of imprecision (small number of events and wide confidence intervals) and high risk of bias in the primary literature. Conclusions A recommendation for routine DUS surveillance of infrainguinal vein grafts remains dependent on low-quality evidence. Considering that DUS offers the opportunity of early intervention and because of its noninvasive nature and low cost, vascular surgeons may incorporate DUS as they individualize the follow-up of lower extremity vein grafts.

Original languageEnglish (US)
Pages (from-to)1885-1891.e8
JournalJournal of Vascular Surgery
Volume66
Issue number6
DOIs
StatePublished - Dec 1 2017

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Meta-Analysis
Veins
Transplants
Confidence Intervals
Ankle Brachial Index
Mortality
Advisory Committees
Amputation
MEDLINE
Blood Vessels
Lower Extremity
Nursing
Extremities
Odds Ratio
Databases
Guidelines
Costs and Cost Analysis
Health

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Systematic review and meta-analysis of duplex ultrasound surveillance for infrainguinal vein bypass grafts. / Abu Dabrh, Abd Moain; Mohammed, Khaled; Farah, Wigdan; Haydour, Qusay; Zierler, R. Eugene; Wang, Zhen; Prokop, Larry J.; Murad, Mohammad H.

In: Journal of Vascular Surgery, Vol. 66, No. 6, 01.12.2017, p. 1885-1891.e8.

Research output: Contribution to journalReview article

Abu Dabrh, Abd Moain ; Mohammed, Khaled ; Farah, Wigdan ; Haydour, Qusay ; Zierler, R. Eugene ; Wang, Zhen ; Prokop, Larry J. ; Murad, Mohammad H. / Systematic review and meta-analysis of duplex ultrasound surveillance for infrainguinal vein bypass grafts. In: Journal of Vascular Surgery. 2017 ; Vol. 66, No. 6. pp. 1885-1891.e8.
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abstract = "Objective Duplex ultrasound (DUS) surveillance of infrainguinal vein bypass grafts is widely practiced, but the evidence of its effectiveness compared with other methods of surveillance remains unclear. Methods Following an a priori protocol developed by the guidelines committee from the Society for Vascular Surgery, this systematic review and meta-analysis included randomized and nonrandomized comparative studies that enrolled patients who underwent infrainguinal arterial reconstruction and received DUS surveillance for follow-up compared with any other method of surveillance. The search included MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scopus through November 2016. Outcomes of interest included all-cause mortality, limb viability, and graft patency reports. Meta-analysis was performed using the random-effects model. Results We included 15 studies. Compared with ankle-brachial index and clinical examination, DUS surveillance was not associated with a significant change in primary, secondary, or assisted primary patency or mortality. DUS surveillance was associated with a nonstatistically significant reduction in amputation rate (odds ratio, 0.70 [95{\%} confidence interval, 0.23-2.13]). The quality of evidence was low because of imprecision (small number of events and wide confidence intervals) and high risk of bias in the primary literature. Conclusions A recommendation for routine DUS surveillance of infrainguinal vein grafts remains dependent on low-quality evidence. Considering that DUS offers the opportunity of early intervention and because of its noninvasive nature and low cost, vascular surgeons may incorporate DUS as they individualize the follow-up of lower extremity vein grafts.",
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N2 - Objective Duplex ultrasound (DUS) surveillance of infrainguinal vein bypass grafts is widely practiced, but the evidence of its effectiveness compared with other methods of surveillance remains unclear. Methods Following an a priori protocol developed by the guidelines committee from the Society for Vascular Surgery, this systematic review and meta-analysis included randomized and nonrandomized comparative studies that enrolled patients who underwent infrainguinal arterial reconstruction and received DUS surveillance for follow-up compared with any other method of surveillance. The search included MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scopus through November 2016. Outcomes of interest included all-cause mortality, limb viability, and graft patency reports. Meta-analysis was performed using the random-effects model. Results We included 15 studies. Compared with ankle-brachial index and clinical examination, DUS surveillance was not associated with a significant change in primary, secondary, or assisted primary patency or mortality. DUS surveillance was associated with a nonstatistically significant reduction in amputation rate (odds ratio, 0.70 [95% confidence interval, 0.23-2.13]). The quality of evidence was low because of imprecision (small number of events and wide confidence intervals) and high risk of bias in the primary literature. Conclusions A recommendation for routine DUS surveillance of infrainguinal vein grafts remains dependent on low-quality evidence. Considering that DUS offers the opportunity of early intervention and because of its noninvasive nature and low cost, vascular surgeons may incorporate DUS as they individualize the follow-up of lower extremity vein grafts.

AB - Objective Duplex ultrasound (DUS) surveillance of infrainguinal vein bypass grafts is widely practiced, but the evidence of its effectiveness compared with other methods of surveillance remains unclear. Methods Following an a priori protocol developed by the guidelines committee from the Society for Vascular Surgery, this systematic review and meta-analysis included randomized and nonrandomized comparative studies that enrolled patients who underwent infrainguinal arterial reconstruction and received DUS surveillance for follow-up compared with any other method of surveillance. The search included MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scopus through November 2016. Outcomes of interest included all-cause mortality, limb viability, and graft patency reports. Meta-analysis was performed using the random-effects model. Results We included 15 studies. Compared with ankle-brachial index and clinical examination, DUS surveillance was not associated with a significant change in primary, secondary, or assisted primary patency or mortality. DUS surveillance was associated with a nonstatistically significant reduction in amputation rate (odds ratio, 0.70 [95% confidence interval, 0.23-2.13]). The quality of evidence was low because of imprecision (small number of events and wide confidence intervals) and high risk of bias in the primary literature. Conclusions A recommendation for routine DUS surveillance of infrainguinal vein grafts remains dependent on low-quality evidence. Considering that DUS offers the opportunity of early intervention and because of its noninvasive nature and low cost, vascular surgeons may incorporate DUS as they individualize the follow-up of lower extremity vein grafts.

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