Outcome of endovascular reintervention for significant stenosis at infrainguinal bypass anastomoses

Abstract

PTA for infrainguinal BAR due to anastomotic stenosis is technically feasible with acceptable durability. PTA for these anastomotic stenoses may be considered a safe option as the first-line treatment.

Paclitaxel-coated versus plain balloon angioplasty in the treatment of infrainguinal vein bypass stenosis

“…Anastomotic stenosis, recurrent vein graft stenosis, smoking, diabetes, renal failure, midgraft lesions, distal anastomotic lesions, multiple bypass lesions, grafts aged <6 months, complex lesions (length >1.5 cm, restenosis, bypass diameter <3 mm), and lesions >2 cm in length have been reported as factors worsening bypass patency after angioplasty. 13,14,[20][21][22][23][26][27][28][29] The only factors influencing patency in our study were proximal in-graft stenosis, which improved patency and bypass failure <6 months after bypass surgery, more than 1 bypass stenosis per graft, and redo bypasses, which impaired assisted primary bypass patency. Renal failure as risk factor was not included into our analysis, because patients in our department with elevated creatinine levels and significant bypass stenosis are usually treated surgically (excluded patients are noted in Fig 1).…”

“…A comparison of our results with the literature is difficult because studies on the management of failing grafts are heterogenous regarding bypass type (autologous vs prosthetic), technique of bypass revision (endovascular vs surgical), start of the follow-up period (moment of bypass implantation vs moment of first bypass PTA), and the technique of angioplasty (simple balloon vs cutting balloon vs drug-eluting balloon). [13][14][15][16][17][18][19][20][21][22][23] Only one study until now has investigated infrainguinal bypass PTA by drug-coated vs plain angioplasty. The BYpass PAClitaxel balloon Study (BYPACS) study, published in 2014, reported outcomes of 32 patients treated with paclitaxel-coated PTA for anastomotic lesions in native or synthetic infrainguinal bypasses.…”

“…Technical success rates are high in patients undergoing balloon angioplasty for infrainguinal bypass stenoses. 13 Alpert et al, 24 which were the first to publish their experience on bypass PTA, reported a technical success rate of >90%. Our results for patency rates of infrainguinal bypasses undergoing angioplasty for high-grade bypass stenoses are competitive.…”

“…Oostenbrugge et al 13 reported outcomes in 43 patients treated for 43 failing peripheral grafts by plain angioplasty of proximal and distal anastomotic lesions. Mean followup was 17 months.…”

The efficacy of salvage interventions on threatened distal bypass grafts

“…5,6 Subsequent secondary interventions occur in around 30% to 50% 3,7 of grafts and include angioplasty of inflow, outflow or graft stenosis, thrombolysis, or surgical interventions with an overall technical success greater than 90%. 8,9 For distal bypasses this improves the patency of grafts at 1 year from 62% (primary) to 83% (assisted primary). 3 However, there remains a paucity of data regarding the frequency, timing, and optimal management, particularly in threatened distal bypass grafts.…”