Abstract
The aim of this study was to assess the results of surgical and endovascular treatment of failing or failed infrainguinal vein bypasses. Eight hundred seventy-five patients with peripheral vein bypasses performed during a 5-year period were followed up prospectively by ankle blood pressure measurements and/or duplex scanning at 3, 6, 9, 12, 18, 24, 36, and 48 months. A total of 59 (7%) grafts required revision during the study period. Fifty-six juxtaanastomotic or intragraft stenoses in 46 failing but patent bypasses were electively revised. Thirty-one predominantly proximal and midgraft lesions in 28 grafts were treated surgically by patch angioplasty (n= 17), interposition/jump grafting (n= 10), or thromboendarterectomy (n= 4). Twenty-five predominantly distal stenoses in 18 grafts were treated by percutaneous transluminal balloon angioplasty (PTA). With this approach, surgery yielded a higher 12-month “primary” bypass patency after revision (72% vs 37%, P=0.02), a higher secondary patency (81% vs 48%, P=0.05) and a better limb survival (96% vs 64%, P=0.03) than PTA. Following thrombectomy (n=12) or thrombolysis (n= 1) of 13 occluded bypasses, a 6-month “primary” patency after revision of 31%, a secondary patency of 38%, and a limb survival of 61% were achieved. In conclusion surgical repair appears to be the most durable procedure in the management of threatened infrainguinal vein bypasses. PTA of distal vein graft lesions was associated with a high risk of restenosis and graft failure.
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