Completion Imaging após cirurgia de bypass do membro inferior na doença arterial periférica: uma revisão sistemática

Abstract

Background: Lower extremity bypass (LEB) remains a suitable choice in symptomatic peripheral artery disease patients with a suitable conduit and acceptable surgical risk. The main reason for short-term failure are defects associated with technique or with the graft itself.. Completion imaging (CIM) techniques are used to detect and correct errors occurred during the procedure. The aim of this systematic review is to assess available evidence on the role of CIM in detecting errors and improving patency of LEB. Methods: This systematic review was conducted according to the PRISMA Guidelines. The database MEDLINE was systematically searched from 1990 to December 2020. Studies were included if they presented results about the use of CIM (angiography, angioscopy or DUS) during LEB due to peripheral artery disease. The primary outcomes were: identification of bypass defects, need for reintervention based on intraoperative findings and graft patency. Secondary outcomes were: time, cost, sensibility and specificity. The data was extracted by two investigators following a predefined protocol. A qualitative analysis was then undertaken. Results: The search yielded 571 articles, from which , 17 articles were included in this review: 3 RCTs, 9 prospective and 5 retrospective studies. From the included articles, 4 studied the role of angiography in LEB (Group A), 2 compared the use of CIM (including angiography, DUS or both) with a control group (Group B), 2 compared angiography with DUS (Group C), 8 compared angiography with angioscopy (Group D) and 1 compared angiography, angioscopy and DUS. Conclusions: Evidence suggests that all techniques are useful for the intraoperative detection and correction of technical errors, improving graft patency rates. Even while faced with a lack of quantitative analysis, the available results seem to favor angioscopy and its integration with the other techniques, namely angiography, for better results in terms of overall operative success and graft patency.