Recanalization of the Native Artery in Patients with Bypass Failure

Abstract

Our objective was to evaluate the possible role of endovascular recanalization of occluded native artery after a failed bypass graft in the case of either acute or chronic limb-threatening ischemia otherwise leading to amputation. In a single-center retrospective clinical analysis, from January 2004 to March 2007 we collected 31 consecutive high-surgical-risk patients (32 limbs) with critical limb ischemia following late ([30 days after surgery) failure of open surgery bypass graft reconstruction. All patients deemed unfit for surgery underwent tentative endovascular recanalization of the native occluded arterial tract. The mean follow-up period was 24 (range, 6-42) months. Technical success was achieved in 30 (93.7%) of 32 limbs. The cumulative primary assisted patency calculated by Kaplan-Meyer analysis was 92% and 88%, respectively, at 12 and 24 months. The limb salvage rate approached 90% at 30 months. In conclusion, our experience shows the feasibility of occluded native artery endovascular recanalization after a failed bypass graft, with optimal results in terms of midterm arterial patency and limb salvage. Our opinion is that successful recanalization of the arterial tract previously considered unsuitable for endovascular approach is allowed by improved competency and experience of vascular specialists, as well as the advances made in catheter and guidewire technology. This group of patients would previously have been relegated to repeat bypass grafts, with their inherently inferior patency and recognized added technical demands. We recognize previous surgical native artery disconnection and lack of pedal runoff to be the main cause of technical failure.

Recanalization of native superficial femoral artery chronic total occlusion after failed femoropopliteal bypass in patients with critical limb ischemia

“…More importantly, a straight-line flow to the foot may be established, though temporarily restored (1-to 6-month), which may be sufficient to relieve CLI. 14 Nevertheless, this reintervention rate appears to be acceptable, considering the decent secondary patency rates (1-year, 78%; 3-year, 61%) and limb salvage rates in this selective patient cohort.…”

“…Further, outflow can be improved by correcting distal lesions at the same stage, which may be surgically inaccessible crural and pedal arteries lesions. More importantly, a straight‐line flow to the foot may be established, though temporarily restored (1‐ to 6‐month), which may be sufficient to relieve CLI . The major disadvantage was high incidence of target lesion failure and high reintervention rates.…”

“…The technical success rates were ranging from 89% to 100% and limb salvage rates were 81-94% and 65-96% at 1-and 2-years of follow-up. [14][15][16][29][30][31] One-year primary and secondary patency rates in those studies ranged from 16% to 60% and from 44% to 96%, respectively. [14][15][16]30,31 And the rates of repeated intervention were between 38% and 50%.…”

“…This has led to the notion of performing recanalization of native SFA chronic total occlusions (CTOs) after failed bypass grafts in patients with limb‐threatening ischemia who are poor candidates for surgical reconstruction due to high risk of perioperative complication and mortality. The feasibility of this approach has been demonstrated in other case‐series studies for lesions at various levels …”

“…The feasibility of this approach has been demonstrated in other case-series studies for lesions at various levels. [14][15][16] In the present study, we present our experience with endovascular recanalization of native severely diseased occluded SFA, namely TASC C and D lesions, in patients with CLI after femoropopliteal bypass graft failure. We evaluated the outcomes of this kind of treatment modality and the risk factors of primary patency loss.…”