Laser-Assisted Angioplasty in the Treatment of Prosthetic Graft Stenosis

Abstract

Late failure of peripheral bypass grafts has been treated primarily by secon dary reconstruction. Laser-assisted angioplasty is an optional therapy that the authors investigated in 28 prosthetic grafts over a two-year period.

Twenty-five symptomatic patients with 28 peripheral prosthetic arterial bypass grafts (25 polytetrafluoroethylene [PTFE] grafts and 1 each of knitted Dacron, Teflon, and umbilical vein) demonstrated graft occlusion (25) or high-grade stenoses (3). All patients underwent standard laser-assisted angioplasty using a continuous wave Nd:YAG laser source and hybrid probe.

Twenty-one grafts (75%) were successfully recanalized with adequate resto ration of flow through the conduit. All 7 failures were in occluded PTFE grafts that presented with either recalcitrant lesions (5) or perforations (2) at the distal anastomoses.

There have been 3 long-term failures (14%) to date in the successfully treat ed group, all in PTFE grafts. Two patients suffered recurrent thrombosis and 1 developed an inexplicable graft infection five months after laser treatment.

Laser-assisted angioplasty appears to be a clinically viable alternative treat ment for prosthetic graft stenosis and recanalization of grafts occluded at their distal anastomosis.