Lysis/balloon angioplasty versus thrombectomy/ open patch angioplasty of failed femoropopliteal polytetrafluoroethylene bypass grafts

Abstract

Thrombectomy/open surgical repair is superior to lysis/PTA (or thrombectomy/balloon angioplasty) for the treatment of failed above-knee PTFE FPGs with anastomotic stenoses. Therefore, balloon angioplasty should be reserved for patients who are at high risk for surgery.

Is endovascular therapy effective in acute femoropopliteal bypass graft failure?

“…The surgery and EVT are the main treatment options for the failed FPBG. However, there is no consensus about the treatment approach of the FPBG failure (2,4,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Previous studies indicated that initial success rates of EVT ranged from 70% to 90% and 85% to 95% in the thrombosed and stenosed grafts, respectively, which is consistent with our study (1,6,14,18,19).…”

“…The treatment approach of FPBG failure is still controversial (3-6, 11-15, 19-21, 25-30). In a study performed by Abu Rahma et al, where lysis/PTA therapy and thrombectomy/open patch angioplasty were compared, the higher 2 years patency rates were detected in the surgery as compared to lysis/PTA therapy and these rates were reported as 87% for surgery, 26% for EVT (13). However, they found no statistically significant difference of mortality and morbidity rates between surgery and EVT (13).…”

“…In a study performed by Abu Rahma et al, where lysis/PTA therapy and thrombectomy/open patch angioplasty were compared, the higher 2 years patency rates were detected in the surgery as compared to lysis/PTA therapy and these rates were reported as 87% for surgery, 26% for EVT (13). However, they found no statistically significant difference of mortality and morbidity rates between surgery and EVT (13). In another study by Berridge et al, in which thrombolytic therapy and surgery were compared, no statistically difference was found limb salvage and death rates at 1, 6 and 12 months between surgery and thrombolysis, but they showed major hemorrhage and distal embolization had been more likely in thrombolysis when compared with surgery (16).…”

Successful complex bifurcation stenting of a native SFA after failed femoropopliteal bypass grafting

“…The management options to recanalize an occluded bypass graft include catheter‐directed thrombolysis with possible adjunctive percutaneous transluminal angioplasty (PTA), catheter‐based mechanical thrombectomy with possible additional PTA, or repeat surgery. Table I summarizes the literature comparing these different strategies [12–20]. Critical limb ischemia was the clinical indication in the majority of these studies.…”

A Review of Surgically Treated Patients with Obstruction after Stenting in the Femoropopliteal Artery Region

“…There have also been reports of poor stent patency in such patients. 10,11) Since occlusion often leads to obstruction of the origins of above-knee collaterals and causes severe lower leg ischemia, stenting should not be the first choice to relieve AKF-P (prosthetic graft) bypass occlusion.…”