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Percutaneous transluminal angioplasty of peripheral bypass stenoses

  • Clinical Investigations
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Abstract

Purpose: To assess the success of percutaneous transluminal angioplasty (PTA) in treating peripheral bypass stenoses.

Methods: Patients who received a femoropopliteal or femorocrural bypass graft for limb ischemia were included in a duplex surveillance program. If duplex ultrasound revealed a short (<2 cm) severe (peak systolic velocity ratio ≥4.5) stenosis, patients were scheduled for arteriography and PTA. Fifty-eight peripheral bypass stenoses in 39 grafts in 37 patients were treated with PTA. The cumulative primary patency of treated stenoses was calculated.

Results: During the first year after PTA 31 (53%) treated lesions remained patent, 15 (26%) lesions restenosed at a median interval of 5.0 (range 1–12) months and 4 (7%) bypasses occluded. The cumulative primary patency of 58 treated graft stenoses at 1 year was 60% [95% confidence interval (CI) 46%–74%] and 55% (95% CI 41%–70%) at 2 years. Graft body stenoses showed a better 2-year cumulative primary patency (86%; 95% CI 68%-100%) compared with juxta-anastomotic lesions (45%; 95% CI 29%–62%; p<0.05).

Conclusion: PTA is justifiable as the initial treatment of peripheral bypass stenoses. Nevertheless, the restenosis rate is rather high, especially in juxta-anastomotic lesions. Continuation of duplex surveillance after PTA and timely reintervention is recommended.

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References

  1. Mills JL, Fujitani RM, Taylor SM (1993) The characteristics and anatomic distribution of lesions that cause reversed vein graft failure: A five-year prospective study. J Vase Surg 17:195–206

    Article  CAS  Google Scholar 

  2. Szilagyi DE, Elliott JP, Hageman JH, Smith RF, Dall’olmo CA (1973) Biologic fate of autogenous vein implants as arterial substitutes. Ann Surg 178:232–244

    Article  PubMed  CAS  Google Scholar 

  3. Grigg MJ, Nicolaides AN, Wolfe JHN (1988) Femorodistal vein bypass graft stenoses. Br J Surg 75:737–740

    Article  PubMed  CAS  Google Scholar 

  4. Taylor PR, Wolfe JHN, Tyrrell MR, Mansfield AO, Nicolaides AN, Houston RE (1990) Graft stenosis: Justification for 1-year surveillance. Br J Surg 77:1125–1128

    Article  PubMed  CAS  Google Scholar 

  5. Lundell A, Lindblad B, Bergqvist D, Hansen F (1995) Femoropoplitealcrural graft patency is improved by an intensive surveillance program: A prospective randomized study. J Vase Surg 21:26–34

    Article  CAS  Google Scholar 

  6. Beidle TR, Brom-Ferral R, Letourneau JG (1994) Surveillance of infrainguinal vein grafts with duplex sonography. AJR 162:443–448

    PubMed  CAS  Google Scholar 

  7. Mills JL, Harris EJ, Taylor LM, Beckett WC, Porter JM (1990) The importance of routine surveillance of distal bypass grafts with duplex scanning: A study of 379 reversed vein grafts. J Vase Surg 12:379–389

    Article  CAS  Google Scholar 

  8. Sanchez LA, Suggs WD, Marin ML, Panetta TF, Wengerter KR, Veith FJ (1994) Is percutaneous balloon angioplasty appropriate in the treatment of graft and anastomotic lesions responsible for failing vein bypasses? Am J Surg 168:97–101

    Article  PubMed  CAS  Google Scholar 

  9. Whittemore AD, Donaldson MC, Polak JF, Mannick JA (1991) Limitations of balloon angioplasty for vein graft stenosis. J Vase Surg 14:340–345

    Article  CAS  Google Scholar 

  10. Bandyk DF, Bergamini TM, Towne JB, Schmitt DD, Seabrook GR (1991) Durability of vein graft revision: The outcome of secondary procedures. J Vase Surg 13:200–210

    Article  CAS  Google Scholar 

  11. Spijkerboer AM, Beek FJA, Van der Graaf Y, Eikelboom BC, Mali WPTM (1997) The predictive value of angiographic results for the outcome of percutaneous transluminal angioplasty in stenosed femoral bypass grafts. Cardiovasc Intervent Radiol 20:98–102

    Article  PubMed  CAS  Google Scholar 

  12. Berkowitz HD, Fox AD, Deaton DH (1992) Reversed vein graft stenosis: Early diagnosis and management. J Vase Surg 15:130–142

    Article  CAS  Google Scholar 

  13. Green RM, Ouriel K, Ricotta JJ, DeWeese JA (1986) Revision of failed infrainguinal bypass graft: Principles of management. Surgery 100: 646–654

    PubMed  CAS  Google Scholar 

  14. Cohen JR, Mannick JA, Couch NP, Whittemore AD (1986) Recognition and management of impending vein-graft failure. Arch Surg 121: 758–759

    PubMed  CAS  Google Scholar 

  15. Bandyk DF, Cates RF, Towne JB (1985) A low flow velocity predicts failure of femoropopliteal and femorotibial bypass grafts. Surgery 98: 799–809

    PubMed  CAS  Google Scholar 

  16. Perler BA, Osterman FA, Mitchell SA, Burdick JF, Williams GM (1990) Balloon dilatation versus surgical revision of infra-inguinal autogenous vein graft stenoses: Long-term follow-up. J Cardiovasc Surg 31:656–661

    CAS  Google Scholar 

  17. Laissy J-P, Peillon C, Clavier E, Pernes J-M, Gaux J-C, Watelet J, Testart J, Benozio M (1990) Transluminal angioplasty of failing infrainguinal arterial bypass grafts: Initial and long-term results in 13 patients. Cardiovasc Intervent Radiol 13:14–17

    Article  PubMed  CAS  Google Scholar 

  18. Greenspan B, Pillari G, Schulman ML, Badhey M (1985) Percutaneous transluminal angioplasty of stenotic deep vein arterial bypass grafts. Arch Surg 120:492–495

    PubMed  CAS  Google Scholar 

  19. London NJM, Sayers RD, Thompson MM, Naylor AR, Hartshorne T, Ratliff DA, Bell PRF, Bolia A (1993) Interventional radiology in the maintenance of infrainguinal vein graft patency. Br J Surg 80:187–193

    Article  PubMed  CAS  Google Scholar 

  20. Dunlop P, Varty K, Hartshorne T, Bell PRF, Bolia A, London NJM (1995) Percutaneous transluminal angioplasty of infrainguinal vein graft stenosis: Long-term outcome. Br J Surg 82:204–206

    Article  PubMed  CAS  Google Scholar 

  21. Van der Heijden FHWM, Legemate DA, van Leeuwen MS, Mali WPTM, Eikelboom BC (1993) Value of duplex scanning in the selection of patients for percutaneous transluminal angioplasty. Eur J Vase Surg 7:71–76

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Vascular Surgery, G1-244, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Arjan W. J. Hoksbergen, Dink A. Legemate, Dirk T. Ubbink & Michael J. H. M. Jacobs

  2. Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Jim A. Reekers

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  1. Arjan W. J. Hoksbergen
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  2. Dink A. Legemate
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  4. Dirk T. Ubbink
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  5. Michael J. H. M. Jacobs
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Hoksbergen, A.W.J., Legemate, D.A., Reekers, J.A. et al. Percutaneous transluminal angioplasty of peripheral bypass stenoses. Cardiovasc Intervent Radiol 22, 282–286 (1999). https://doi.org/10.1007/s002709900389

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