The role of intra-operative duplex imaging in arterial reconstructions

Background This study is a cost-benefit analysis of a less invasive method of intra-operative duplex imaging compared with the use of intraoperative angiogram (including C-arm fluoroscopy) in arterial reconstruction. Methods From September 1994 to May 1995, 93 intra-operative duplex imaging studies were performed. Duplex scanning results were recorded for carotid endarterectomy (35), iliac balloon angioplasty and stent placement(12), and infra-inguinal bypass (46). Average cost and time were calculated for each type of study. Results Thirty-four carotid endarterectomy patients (97%) had normal duplex findings. Three (9%) underwent intra-operative angiogram due to abnormal duplex findings and post-operative neurological deficit. In iliac balloon angioplasty and stent placement cases (12), both intra-operative duplex and C-arm post-stent angiography yielded comparable results in both normal (11) and abnormal (1) studies. In infra-inguinal bypass cases (46), 2 had abnormal duplex findings of the native vessels. Average time and cost required to perform intra-operative duplex studies is significantly less than that required for intra-operative angiogram or C-arm studies. Conclusion Compared with traditional intraoperative angiography, the use of intra-operative duplex imaging is less expensive, less invasive, quicker, and equally accurate when used as an adjunct to access surgical results of arterial reconstructions