Durability of vein graft revision: The outcome of secondary procedures

Abstract

Occlusive lesions that reduced graft blood flow and ankle systolic pressure were identified in 83 femorodistal saphenous vein bypasses by use of duplex scanning or arteriography. Sites of stenosis included vein conduit (n = 41), anastomoses (n = 20), outflow arteries (n = 15), or inflow (n = 9) arteries. One hundred three secondary procedures consisting of vein-patch angioplasty (n = 31), sequential (n = 21) or interposition (n = 17) graft placement, percutaneous transluminal balloon angioplasty (n = 17), or excision of the lesion and primary anastomosis (n = 16) were performed to correct primary (n = 85) or recurrent (n = 18) graft stenoses. Cumulative graft patency after reintervention was 96% at I year, and 85% at 5 years. Stenosis or occlusion of revision sites was less after excision (0 of 16) or replacement (1 of 17) of abnormal segments compared to vein-patch angioplasty (8 of 31) or balloon angioplasty (9 of 18). Sequential or jump grafts constructed to improve graft outflow impaired by either myoinfimal or atherosclerotic occlusive lesions were the least durable secondary procedures. Five of eight graft failures in this series resulted from sequential/jump graft occlusion. All categories of secondary procedures normalized graft and limb hemodynamics, although only one third of patients reported symptoms of limb ischemia before revision. Surveillance of infrainguinal vein bypasses for occlusive lesions is a valid concept to salvage patent but hemodynamicallyfailing grafts. Secondary procedures that excised the lesion, used autologous tissue reconstruction, and normalized hemodynamics at the revision site and in the vein bypass were associated with a low incidence of restenosis and prolonged graft patency. (J VASC SURG 1991;13:200-10.) 204 Bandyk et al.

Infrainguinal vein graft stenosis: Cutting balloon angioplasty as the first-line treatment of choice

“…Landry et al 3 demonstrated an 87% assisted primary patency at 5 years after OS revision of vein bypass grafts. Sanchez et al 6 reported an 86% primary patency at 21 months, and Bandyk et al 17 found an 85% primary patency rate at 5 years after OS.…”

Editor's Choice – Follow-up of Patients After Revascularisation for Peripheral Arterial Diseases: A Consensus Document From the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery

“…The first-year incidence of vein graft stenosis is 20%. 41,42 During the first 3 months, bypass stenosis/ thrombosis can be due to technical issues. Almost 15% of graft failures occur during the first month; almost 80% during the first 2 years and no more than 5% thereafter.…”

Surgical and endovascular revision of infrainguinal vein bypass grafts: Analysis of midterm outcomes from the PREVENT III trial

“…1-3 Vein graft revision before graft failure has offered patency rates approaching those of grafts not necessitating intervention. 8,[15][16][17] An understanding of the factors surrounding vein graft revisions has been obtained through a collection of previous single-institution retrospective studies. 9,10,18,19 Inherent in these studies is the potential nonuniformity of data collection, the inherent difficulty in maintaining a large cohort for serial follow-up of patients, and variability in the threshold for reintervention of the failing graft.…”