Poor adherence to ultrasound surveillance is associated with infrainguinal bypass graft failure - An ongoing challenge in Australia.

Backgrounds: Infra-inguinal bypass (IIB) surgery is a time-proven and reliable management avenue for the treatment of peripheral arterial disease (PAD). The importance of ultrasound surveillance in maintaining IIB graft patency is well-recognised, yet adherence rates are underreported. This study evaluates the impact of surveillance compliance on graft outcomes in an Australian setting.

Methods: A cross-sectional analysis of IIBs performed between 2010 and 2020 at a major vascular surgical institution in Australia was conducted retrospectively. Demographic data, peri-operative comorbidities and configuration of the bypass were captured as well as post-discharge results. Surveillance compliance was assessed based on adherence to post-operative ultrasound and clinic visits. The chief outcome measure was graft occlusion within 2 years. Secondary outcomes were major amputation, mortality and ambulatory function.

Results: Over a time period of 10 years, 239 bypasses were carried out on 207 individuals. 83% complied with surveillance protocols. Adherence rates were lower in regional patients. Non-compliance was significantly associated with vein graft occlusions (p < 0.01) but not with synthetic grafts. Regional referrals (p < 0.01), low pre-operative haemoglobin (p < 0.01), post-operative transfusion (p = 0.02) and use of prosthetic conduit (p < 0.01) were identified as significant predictors of graft thrombosis. Patients with occluded grafts were at substantially higher risk of ambulatory deterioration (2.4 fold), major limb amputation or death (8.6 fold) within 12 months. One-year survival without amputation was 88.3%.

Conclusion: Enhanced bypass graft surveillance is essential in clinical practice to minimise graft occlusion, reduction in morbidity, limb loss and death. This study reveals suboptimal compliance in Australian vascular surgical setting, particularly in regional areas, underscoring the need for improved education, resource allocation and infrastructural development.