Surgical and endovascular intervention for infrainguinal vein graft stenosis

Abstract

The revision of duplex scan-detected vein graft stenosis with surgical or endovascular techniques was associated with an excellent patency rate, including when intervention on alternative vein conduits or treatment of restenosis was necessary. When PTA was selected on the basis of clinical and duplex scan selection criteria, the endovascular treatment of focal vein graft stenosis was effective, durable, and comparable with the surgical revision of more extensive lesions.

Predictors of failure after angioplasty of infrainguinal vein bypass grafts

“…At follow-up, we identified a total of 42 PTA failures. The ultimate fate of these grafts was: surgical revision (18), redo-PTA (15), amputation (5), and observation of asymptomatic restenosis (4). Of the five major amputations one occurred after a motor vehicle accident and four after failed surgical graft revisions.…”

“…3 With the increasing use of duplex ultrasound scan surveillance, early detection of graft stenosis is possible and permits correction of hemodynamically significant lesions before graft thrombosis occurs. 4,5 Traditionally, these lesions have been repaired with surgical revision, including patch angioplasty, interposition bypass, or jump graft. Successful treatment has been associated with excellent secondary patency rates.…”

Balloon angioplasty for revision of failing lower extremity bypass grafts

“…Surgical revision has been the gold standard in the management of failing bypass grafts because it is associated with excellent patency rates. 29 However, operative revision in a scarred field may be associated with a high incidence of complications, including nerve injury, wound and graft infection, increased blood loss, and prolonged operative time. Moreover, revision often requires an additional autogenous conduit that may not be available or may by itself be at risk of development of graft stenosis.…”

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery,⁎⁎AAVS/SVS when Guideline initiated, now merged into SVSSociety for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guideline

“…Overall outcomes of PTA and stenting of native vessels are summarized in Table 21 in the full-text guidelines. Percutaneous transluminal angioplasty of vein bypass graft stenoses has also been reported, with 1-to 3-year patency rates of the treated site of approximately 60% (81)(82)(83), comparable to surgical repair (81). Percutaneous transluminal angioplasty of multiple vein graft stenoses has a much lower 3-year patency rate of only 6% (82).…”