Recanalization of Failed Autogenous Conduit Utilizing Laser Revascularization

Abstract

The traditional approach for the treatment of restenosis of autogenous vein bypass has been revision of bypass with vein patch angioplasty, interposition jump graft, or thrombectomy procedures for those patients with extensive occlusive disease and limb-threatening ischemia. Endovascular intervention traditionally involves angioplasty of the graft; however, vessels with diffuse disease or extensive longitudinal lesions are generally difficult to revascularize utilizing this technique. Surgical revision of a threatened autogenous vein graft may carry a morbidity rate as high as 13.6%. We present a series of cases in which excimer laser atherectomy (LA) was used to recanalize an occluded autogenous saphenous vein bypass. Of the occluded vein bypasses failed angioplasty and were successfully atherectomized with LA measuring lengths of 35 and 30 cm, respectively. The infrainguinal has a 6-month follow-up, while the infragencular has a follow-up of 1 year, with resolution of presenting symptoms.

Laser Uses in Noncoronary Arterial Disease

“…Three articles described other off-label excimer laser indications in endovascular therapy. First, Chander et al [34] reported a case series of 4 recanalizations of failed autogenous saphenous vein graft using laser revascularization. A 0.9 to 1.7 TE laser catheter was used with 100% technical success.…”