Target lesion characteristics in failing vein grafts predict the success of endovascular and open revision

Abstract

Grafts that develop early lesions fare poorly regardless of treatment modality. Lesions involving anastomoses of failing grafts are better treated with open revision, but patency after treatment of such lesions is still worse than treatment of mid-graft lesions. In contrast, the method of treatment does not influence outcome after treatment of mid-graft target lesions. Thus, endovascular therapy should be reserved for focal, late-appearing lesions involving the mid-graft.

Balloon angioplasty for revision of failing lower extremity bypass grafts

“…17 Determining the utility of any treatment for failing grafts is made difficult by the variety of treatment options, the frequent multiplicity of lesions, and specific lesion characteristics, including length, location, and temporal development after graft implantation. 18 Traditional operative techniques, such as patch angioplasty, interposition, or jump graft, remain the gold standard for the management of failing grafts. However, these techniques require the availability of an additional autogenous conduit and carry the risk of morbidity and mortality associated with reoperation.…”

Outcomes of reinterventions after subintimal angioplasty

“…8 This pattern of decreased limb salvage rate after reintervention has also been seen in open and endoluminal interventions after failing surgical bypass. 1,[9][10][11] Technical success for reintervention was better than that for index SIA (94% vs 87%). 8 Only one patient required an outback catheter to achieve re-entry.…”

“…This percentage is similar to studies on reintervention for surgical bypasses, where approximately 15% to 20% undergo revision. [9][10][11] The mean time to reintervention, however, is much shorter for SIA at 7.8 months compared with surgical bypass at 12 to 15 months. There were no statistically significant differences in risk factors or disease classification in patients who underwent bypass versus reintervention.…”

“…8 Inferior patency rates after reintervention have also been seen in open and endovascular therapy for failing surgical bypass grafts. 1,[9][10][11] These reinterventions, however, can provide good limb salvage and clinical outcomes without the cost and morbidity of open redo bypasses. 12,13 There are several reasons for inferior patency rates after reintervention.…”

“…Interventions after surgical bypass have also had similar worse outcomes for early failure; however, early failure for surgical bypass is usually described as Յ6 months. 1,[9][10][11] Early failure after SIA may reflect either more advanced disease, more severe inflammatory response, or inadequate initial procedure; hence, leading to a worse outcome after reintervention. This study also found a worse outcome in reintervention for CLI.…”