Steven Rogers ^{a, b}, Joao Carreira ^b, Alison Phair ^a, Christabel Olech ^a, Jonathan Ghosh ^c, Charles McCollum ^a

^a Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, UK, M23 9LT.

^b Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, UK, M23 9LT.

^c Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Southmoor Road, Manchester, UK, M23 9LT.

Background

Vein mapping using duplex ultrasound (DUS) is routine in selecting optimal autologous bypass grafts (aBG), but is time-consuming and operator-dependent. 3D tomographic ultrasound (tUS) is a free-hand, high resolution, electromagnetically tracked technology using frame-grab techniques. This study compares tUS with DUS for mapping  potential  autologous grafts for coronary and lower limb arterial bypass.

Methods

DUS and tUS imaging performed immediately before bypass surgery were compared. The time in minutes to acquire each modality was recorded. Operating surgeons post-operatively scored the quality of the potential aBG. A score of 5 was complete agreement with preoperative imaging with scores of 4 considered “good”.

Results

434 potential aBG in 200 patients were imaged. DUS imaging took a mean (+/-sd) of 08:26±04:44mins compared with 01:00±00:25mins for tUS (p<0.0001). DUS reporting took a mean of 09:03±09:12mins compared with 19:31±12:41mins for tUS processing (p<0.0001), which requires a vascular scientist. 64 (32%) surgeons felt that tUS images would have changed the harvest choice. 97 (60%) surgeons agreed that tUS aBG reconstructions compared more closely with the operative findings compared to 88 (54%) for DUS. 113 (57%) surgeons felt that tUS could replace DUS entirely.

Conclusions

Surgeons preferred to see tUS images of the potential aBG themselves rather than relying on DUS reports. tUS images were significantly quicker than DUS to acquire and required less operator skill but more computer processing time. tUS could significantly improve NHS capacity.

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