Infrainguinal vein bypass graft revision: Factors affecting long-term outcome

Abstract

Vein graft revisions offer durable patency and limb salvage rates after repair of stenotic infrainguinal bypass grafts. Vigilant ongoing surveillance is essential, because 30.9% of revised grafts will develop additional lesions that will require repair. Tibial level bypass grafts that require early repeat intervention to treat graft stenosis are at particular risk for development of subsequent lesions.

Classification and Clinical Impact of Restenosis After Femoropopliteal Stenting

“…ISR ϭ in-stent restenosis. 78.8% to 87.7%, respectively (11). In this study, the freedom from recurrent ISR and occlusion rate after balloon angioplasty for stenotic ISR was 46.7% to 50.1% and 81.1% to 84.1% at 2 years, respectively.…”

Endovascular treatment of femoropopliteal steno-obstructive disease with percutaneous transluminal angioplasty: midterm results

“…In the study by Gordon et al on lesions with a mean length >14 cm, the 1-year primary and secondary patency rates of stainless steel stents (Wallstent) were 22% and 30%, respectively [7]. For these reasons, surgical bypass grafting whenever possible with autologous saphenous vein (on site or reversed) has become the treatment of choice for long lesions, with 5-year patency rates of 50%-75%, that is, higher than those provided by PTA alone, as confirmed by the study of Nguyen [15] and by the recent BASIC trial (Bypass or Angioplasty in Severe Intermittent Claudication) (2004) [16]. These data lend support to the TASC recommendations to use endovascular PTA for type A lesions, and surgical treatment for long, type D lesions; precise indications for the intermediate class B and C lesions are lacking [8].…”

“…In our experience, instead, indications for stent placement were dissection obstructing secondaria ad 1 anno per gli stent in acciaio (Wallstent) pari al 22% e 30%, rispettivamente [7]. Per tali motivi, in caso di occlusione lunga la rivascolarizzazione chirurgica, basata sul confezionamento di by-pass, eseguiti ove possibile con vena safena autologa (in situ o invertita), rappresenta a tutt'oggi la terapia di scelta con pervietà a 5 anni variabile tra il 50% e il 75%, superiore al solo trattamento di PTA come anche dimostrato dallo studio di Nguyen [15] e dal recente trial BASIC (Bypass or Angioplasty in Severe Intermittent Claudication) (2004) [16]. Tali dati giustificano e supportano le raccomandazioni suggerite dal TASC per cui il trattamento endovascolare con PTA è consigliato per lesioni di tipo A mentre il trattamento di tipo chirurgico è consigliato per lesioni lunghe, di tipo D, in assenza tuttavia di precise indicazioni per le classi intermedie (B e C) [8].…”

Single-Center Experience in Endovascular Treatment for Infrainguinal Bypass Obstructions

“…Whereas the present series revealed 1-year primary patency rates of 74% and 27% in cases of IC and CLI, respectively, Alexander and Katz (26) reported a failure rate of 53.6% at 1 year. In comparison, one surgical series (30) showed a primary patency rate of 49.3% throughout 5 years. This observation of lower primary patency rates in CLI is well recognized and was strengthened by our multivariate analysis, with presence of CLI and diabetes mellitus identified as independent risk factors for impaired primary patency.…”