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

Schneider, Peter A.; Michael, T.; Nelken, Nicolas A.

doi:10.1016/j.jvs.2007.12.035

Cited by 36 publications

(18 citation statements)

References 21 publications

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“…16,32 Studies of CBA, however, systematically excluded longer lesions. 20,30,33 Our results extend the findings of CBA for treatment of stenoses in infrapopliteal grafts and, by using receiver operating characteristic analysis, we were able to more rigorously determine the lesion length associated with restenosis. Given the lower rates of mortality and MACE in patients with shorter compared to those with longer lesions, lesion length in this cohort may reflect a greater systemic burden of disease.…”

Section: Discussionsupporting

confidence: 71%

“…First reported by Engelke et al in 2002, CBA of infrainguinal graft stenosis has subsequently been shown to have acceptable short-time patency rates, superior to standard balloon angioplasty and comparable to open surgical revision in selected patients. 29,30 Positive results have not been uniformly observed, however, and even though the use of cutting balloons may provide good early results, CBA use does not eliminate the late risk of restenosis. 20,31 …”

Section: Discussionmentioning

confidence: 99%

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Endovascular Therapy is Effective Treatment for Focal Stenoses in Failing Infrapopliteal Vein Grafts

Westin

Armstrong

Javed

et al. 2014

Annals of Vascular Surgery

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Objective To evaluate the efficacy of endovascular therapy for maintaining patency and preserving limbs among patients with failing infrapopliteal bypass grafts. Methods We gathered data from a registry of catheter-based procedures for peripheral artery disease. Of 1554 arteriograms performed from 2006 to 2012, 30 patients had interventions for failing bypass vein grafts to infrapopliteal target vessels. The first intervention for each patient was used in this analysis. Duplex ultrasonography was used within 30 days after intervention and subsequently at 3-6 month intervals for graft surveillance. Results Interventions were performed for duplex ultrasonography surveillance findings in 21 patients and for symptoms of persistent or recurrent critical limb ischemia in 9 patients. Procedural techniques included cutting balloon angioplasty (83%), conventional balloon angioplasty (7%), and stent placement (10%). Procedural success was achieved in all cases. There were no procedure-related complications, amputations, or deaths within 30 days. By Kaplan-Meier analysis, 37% were free from graft restenosis at 12 months and 31% were at 24 months. Receiver operating characteristic analysis indicated that a lesion length of 1.75 cm best predicted freedom from restenosis (C statistic: 0.74). Residual stenosis (P=0.03), patency without reintervention (P=0.01), and assisted patency with secondary intervention (P=0.02) rates were superior for short lesions compared to long lesions. The cohort had acceptable rates of adverse clinical outcomes, with 96% of patients free from amputation at both 12 and 24 months; clinical outcomes were also better in patients with short lesions. Conclusions In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, rates of limb preservation were high, but the majority of patients developed graft restenosis within 12 months. Grafts with longer stenoses fared poorly by comparison. These data suggest that endovascular interventions to restore or prolong graft patency may be associated with maintained graft patency and that close follow up with vascular laboratory surveillance is essential.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Endovascular Therapy is Effective Treatment for Focal Stenoses in Failing Infrapopliteal Vein Grafts

Westin

Armstrong

Javed

et al. 2014

Annals of Vascular Surgery

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“…Schneider et al [14] reported that 50% of failing grafts were detected within 1 year after bypass. Based on this observation, they recommended more frequent DUS examinations of the vein graft within the first 1 or 2 years after LE bypass grafting.…”

Section: Discussionmentioning

confidence: 99%

“…Mills et al [13] reported that the proximal and the distal anastomosis was similar in frequency of stenotic lesions. According to Berkowitz et al [15] and Schneider et al [14], 40% of stenotic lesions were located within 4 cm of the proximal anastomosis due to the location of venous valves or intraoperative vein graft injury from clamping or manipulation. However, Avino et al [2] and Berceli et al [10] reported that stenotic lesions were most commonly seen midgraft due to the diameter of the vein graft and the location of the vein valve.…”

Section: Discussionmentioning

confidence: 99%

Treatment of failing vein grafts in patients who underwent lower extremity arterial bypass

Park

Yang

et al. 2012

J Korean Surg Soc

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PurposeWe attempted to determine risk factors for the development of failing vein graft and optimal treatment in patients with infrainguinal vein grafts.MethodsWe retrospectively reviewed a database of patients who underwent infrainguinal bypass using autogenous vein grafts due to chronic atherosclerotic arterial occlusive disease of lower extremity (LE) at a single institute between September 2003 and December 2011. After reviewing demographic, clinical, and angiographic features of the patients with failing grafts, we analyzed those variables to determine risk factors for the development of failing grafts. To determine an optimal treatment for the failing vein grafts, we compared results of open surgical repair (OSR), endovascular treatment (EVT) and conservative treatment.ResultsTwo hundred and fifty-eight LE arterial bypasses using autogenous vein grafts in 242 patients were included in this study. During the follow-up period of 39 ± 25 months (range, 1 to 89 months), we found 166 (64%) patent grafts with no restenosis, 41 (15.9%) failing grafts, 39 (15.1%) graft occlusions, and 12 (4.7%) grafts lost in follow-up. In risk factor analysis for the development of a failing graft, no independent risk factors were identified. After 50 treatments of the 41 failing grafts (24 OSR, 18 EVT, 8 conservative management), graft occlusion was significantly more common in conservative treatment group and severe (>75%) restenosis was significantly more common following EVT than OSR (P = 0.001). Reintervention-free graft patency was also superior in the OSR group to that of the EVT group (87% vs. 42%, P = 0.015).ConclusionOSR of failing grafts has better outcomes than EVT or conservative management in treating failing grafts.

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“…6 In the last few years, a new system of balloon angioplasty has emerged; based on a controlled and less traumatic dilation of the lesion, cutting balloon angioplasty (CBA) has the potential to improve the outcome of catheter-based therapy by minimizing elastic recoil and achieving better angiographic results. [7][8][9] To the best of our knowledge, there are no reports about the efficacy of CBA in infrapopliteal lesions involving the arterial bifurcations. Hence, the aim of our pilot study was to evaluate the safety, feasibility, and effectiveness of the cutting balloon in the management of infrapopliteal bifurcation lesions.…”

Section: Introductionmentioning

confidence: 99%

Cutting Balloon Angioplasty in the Treatment of Short Infrapopliteal Bifurcation Disease

et al. 2015

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

Abstract: Cutting balloon angioplasty is a reasonable, initial treatment for infrainguinal vein graft stenosis in most patients. It is a safe, minimally invasive, outpatient procedure with patency rates that are comparable to OS and superior to PTA.

Cited by 36 publications

References 21 publications

Endovascular Therapy is Effective Treatment for Focal Stenoses in Failing Infrapopliteal Vein Grafts

Endovascular Therapy is Effective Treatment for Focal Stenoses in Failing Infrapopliteal Vein Grafts

Treatment of failing vein grafts in patients who underwent lower extremity arterial bypass

Cutting Balloon Angioplasty in the Treatment of Short Infrapopliteal Bifurcation Disease

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