Vascular surgery


high volume centres, we have a responsibility to provide the evidence,” says Mr Lukla Biasi. “Guidelines are there to bring us together as a group of physicians. We need to educate, collect the data, and inform the guidelines. The guidelines do not consistently mention intraoperative Doppler, and yet we have demonstrated that it is fundamental to first line assessment.”


Conclusion “An intraoperative Doppler is cheap, it’s fast, it’s reliable, and at a bare minimum should be the bar for evaluating a bypass…We should be doing more than just pulse palpation,” concludes Dr. Leigh Ann O’Banion. Ultimately, intraoperative Doppler probes, when used for patency assessment at the time of revascularisation surgery, can help surgeons ‘close with confidence’. However, there is wide variation in completion assessment practices, across healthcare providers, and a need for the vascular surgery community to come together to inform future guidance.


CSJ


References 1. The European Society for Vascular Surgery guidelines can be accessed at: https:// esvs.org/guidelines/


2. The Society for Vascular Surgery guidelines can be accessed at: https://vascular.org/ vascular-specialists/practice-and-quality/ clinical-guidelines/clinical-guidelines-and- reporting


3. Normahani P, Poushpas S, Alaa M, Bravis V, Sounderajah V, Aslam M, Jaffer U. Diagnostic Accuracy of Point-of-care Tests Used to Detect Arterial Disease in Diabetes: TEsting for Arterial Disease in Diabetes (TrEAD) Study. Ann Surg. 2022 Nov 1;276(5):e605-e612. doi: 10.1097/ SLA.0000000000004545. Epub 2020 Dec 29. PMID: 33630461.Copy


Further reading l Björck, M., et al. (2020). Editor’s Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. European Journal of Vascular and Endovascular Surgery, 59(2), 173–218. https://doi. org/10.1016/j.ejvs.2019.09.006


l Björck, M., et al. (2017). Editor’s Choice – Management of the Diseases of Mesenteric Arteries and Veins. European Journal of Vascular and Endovascular Surgery, 53(4), 460– 510. https://doi.org/10.1016/j.ejvs.2017.01.010


l Conte, M. S., et al. (2019). Global vascular guidelines on the management of chronic limb-threatening ischemia. Journal of Vascular Surgery, 69(6), 3S-125S.e40. https://doi.


Intraoperative Doppler probes, when used for patency assessment at the time of revascularisation surgery, can help surgeons ‘close with confidence’


org/10.1016/j.jvs.2019.02.016


l Dalman, R. L., John Harris, E., & Zarins, C. K. (1996). Is completion arteriography mandatory after reversed-vein bypass grafting? Journal of Vascular Surgery, 23(4), 637–644. https://doi. org/10.1016/S0741-5214(96)80044-9 Naylor, A. R. (2000). Making carotid surgery safer. British Medical Bulletin, 56(2), 539–548. https://doi. org/10.1258/0007142001903184


l Naylor, A. R., Bell, P. R. F., & Ruckley, C. v. (1992). Monitoring and cerebral protection during carotid endarterectomy. Journal of British Surgery, 79(8), 735–741. https://doi. org/10.1002/bjs.1800790805 Naylor, A. R., & Gaunt, M. E. (1996). Quality Control during Carotid Endarterectomy. Vascular Medicine, 1(2), 125–132. https://doi.org/10.1177/1358863X9600100207


l Naylor, R., et al. ESVS Guidelines Committee, Antoniou, G. A., Bastos Goncalves, F., Bjorck, M., Chakfe, N., … Stone, D. H. (2023). Editor’s Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. European Journal of Vascular and Endovascular Surgery, 65(1), 7– 111. https://doi.org/10.1016/j.ejvs.2022.04.011


l Proia, R. R., et al. (2001). Early results of infragenicular revascularization based solely on duplex arteriography. Journal of Vascular Surgery, 33(6), 1165–1170. https://doi. org/10.1067/mva.2001.115376


l Scali, S. T., et al. (2011). Completion duplex ultrasound predicts early graft thrombosis after crural bypass in patients with critical limb ischemia. Journal of Vascular Surgery,


54(4), 1006– 1010. https://doi.org/10.1016/j. jvs.2011.04.021


l Sharpe, R., et al. (2012). The War Against Error: A 15 Year Experience of Completion Angioscopy Following Carotid Endarterectomy. European Journal of Vascular and Endovascular Surgery, 43(2), 139–145. https://doi.org/10.1016/j. ejvs.2011.09.01


SCAN ME


An educational webinar, sponsored


by Huntleigh, explores these themes and issues in more depth, including


clinical case studies from top vascular surgeons. To view the webinar,


Patency Assessment at the Time of Revascularisation Surgery: How to Close with Confidence, scan the QR code above.


February 2026 I www.clinicalservicesjournal.com 31


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