Abstract
Purpose
The aim of this study was to assess the efficacy of cutting-balloon angioplasty (CBA) in the treatment of anastomotic stenoses of peripheral arterial bypass grafts.
Materials and methods
Seventeen patients (12 men and five women; age range 54–79 years, mean age 66.5) with stenosis or occlusion at the proximal or distal anastomoses of peripheral bypass grafts were treated with CBA. The diagnosis of stenosis was based on clinical and colour-Doppler ultrasound findings and confirmed by angiography with measurement of the intraluminal transstenotic pressure gradients. The diameter of the selected cutting balloon was 1-mm smaller than the vessel distal to the anastomosis and, in the event of suboptimal outcome, the procedure was completed with repeat dilatation with a larger standard balloon (+1 mm).
Results
Technical success was obtained in 100% of cases. In three patients, CBA was performed after locoregional thrombolysis. No patient required stent placement or emergency surgery due to the presence of residual stenosis, suboptimal outcome or dissection. No complication occurred either during or after the procedure. During a mean follow-up period of 10.4 months (range 5–21 months), two restenoses developed at 9 and 7 months, which were treated with the same technique; in one patient with recurrent bypass occlusion at 5 months, a new bypass was created surgically owing to contraindications for locoregional thrombolysis. Cumulative primary patency at 12 and 18 months was 82.35%, whereas the two cases of restenoses treated with repeat CBA underwent further follow-up at 10 and 7 months, respectively.
Conclusions
Our data confirm the efficacy of CBA in the treatment of anastomotic stenoses of peripheral arterial bypass grafts.
Riassunto
Obiettivo
Analizzare l’efficacia dell’angioplastica con cutting balloon (CB) nel trattamento delle stenosi anastomotiche dei bypass arteriosi periferici.
Materiali e metodi
Diciassette pazienti (12 uomini, 5 donne; età 54-79 anni, media 66,5 anni) con stenosi od occlusione in corrispondenza delle anastomosi prossimale o distale di bypass periferico sono stati sottoposti ad angioplastica con CB. La diagnosi di stenosi è stata formulata sulla base dei dati clinici, mediante esame ecocolor doppler e confermata dall’angiografia conmisurazione dei gradienti pressori endoluminali transtenosi. Il diametro del CB è stato scelto 1 mm inferiore rispetto al vaso distale all’anastomosi ed in caso di risultati non ottimali la procedura è stata completata con un’altra dilatazione con palloncino standard di diametro superiore (1 mm).
Risultati
Il successo tecnico della procedura è stato ottenuto nel 100% dei casi. In tre pazienti l’angioplastica con CB è stata eseguita dopo trombolisi locoregionale. In nessun caso è stato necessario posizionare uno stent o eseguire un intervento chirurgico d’urgenza per la presenza di stenosi residue, risultati sub-ottimali o dissezioni. Non è stata rilevata nessuna complicanza durante e dopo la procedura. Durante un follow-up variabile tra 5 e 21 mesi (media 10,4 mesi), sono state evidenziate 2 restenosi a 9 e 7 mesi trattate con medesima tecnica; in un paziente con occlusione ricorrente del bypass a 5 mesi è stato confezionato chirurgicamente un nuovo bypass vista la presenza di controindicazioni alla terapia trombolitica locoregionale. La pervietà primaria cumulativa a 12 e 18 mesi è stata dell’82,35% mentre i due casi di restenosi trattate con CB hanno presentato un ulteriore follow-up rispettivamente di 10 e 7 mesi.
Conclusioni
I nostri dati confermano l’efficacia del CB nel trattamento delle stenosi anastomotiche dei bypass arteriosi periferici.
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Basile, A., Tsetis, D., Chlouverakis, G. et al. Treatment of anastomotic stenoses of peripheral bypass grafts with cutting balloon angioplasty. Radiol med 113, 719–726 (2008). https://doi.org/10.1007/s11547-008-0275-4
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DOI: https://doi.org/10.1007/s11547-008-0275-4