Surgical treatment of threatened reversed infrainguinal vein grafts

Nehler, Mark R.; Moneta, Gregory L.; Yeager, Richard A.; Edwards, James M.; Taylor, Lloyd M.; Porter, John M.

doi:10.1016/0741-5214(94)90280-1

Cited by 63 publications

(48 citation statements)

References 29 publications

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“…These findings are in line with the currently available literature on endovascular treatment of bypass graft obstructions (Table 4) (21,26 -28,30 -34) reporting primary assisted patency rates as high as 72% at 9 months (31). In contrast, surgical data revealed primary assisted patency rates as high as 92% throughout 5 years (28). Of note, in a nonrandomized series comparing surgical with endovascular bypass graft revision, Avino and colleagues (32) disproved these findings.…”

Section: Discussionmentioning

confidence: 80%

“…In a similar setting, Alexander and Katz (26) reported serious complications (pseudoaneurysms, thromboembolic events, pulmonary edema with myocardial infarction, graft rupture, and contrast agent-induced nephropathy) in as many as 8% of patients subsequent to endovascular revascularization of bypass graft obstructions. Studies describing outcomes subsequent to open surgical bypass treatment reported complications in as many as 15%-20% of cases (27)(28)(29). These data, although derived from nonrandomized comparisons, favor endovascular revascularization to revise infrainguinal bypass obstructions.…”

Section: Discussionmentioning

confidence: 87%

See 1 more Smart Citation

Single-Center Experience in Endovascular Treatment for Infrainguinal Bypass Obstructions

Baumann

Engelberger

Makaloski

et al. 2012

Journal of Vascular and Interventional Radiology

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 87%

Single-Center Experience in Endovascular Treatment for Infrainguinal Bypass Obstructions

Baumann

Engelberger

Makaloski

et al. 2012

Journal of Vascular and Interventional Radiology

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“…Color-flow duplex scanning, a noninvasive and relatively inexpensive procedure, can accurately detect the development of hemodynamically significant stenoses. Treatment of hemodynamically significant lesions in patent but hemodynamically failing vein grafts results in 5-year assisted primary patency rates in more than 80% of patients [30][31][32][33][34][35]. Angiography should be considered when the clinical and vascular laboratory findings are abnormal or equivocal.…”

Section: Management After Revascularization For Critical Limb Ischemiamentioning

confidence: 95%

Critical limb ischemia

Dawson

Hagino

2001

Curr Treat Options Cardio Med

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Patients with critical limb ischemia (CLI) present with ischemic rest pain or with tissue loss. Tissue loss, in its mildest presentation, includes focal ischemic ulceration or nonhealing wounds. Gangrene is the manifestation of severe chronic ischemia. Without revascularization, patients with CLI are at risk for limb loss and for potentially fatal complications from the progression of gangrene and the development of sepsis. The best patient outcomes are achieved when the diagnosis and appropriate treatment for CLI are not delayed. Simple noninvasive tests, such as measurement of ankle-to-brachial indices or toe Doppler pressures, take only minutes to provide sufficient information to confirm the diagnosis of peripheral artery disease (PAD) and to document the severity of limb ischemia. Subsequent diagnostic imaging studies, such as arteriography, magnetic resonance angiography, or ultrasound duplex scanning, provide the detailed information needed to plan revascularization therapy. Balloon angioplasty and stenting work best for focal segments of narrowing or short occlusions of the iliac arteries, but endovascular treatments yield progressively poorer results with longer and more distal lesions. Long segments of occlusion, especially those distal to the common femoral artery, are best treated with surgical bypass. Pharmacotherapy and adjunctive therapies, such as topical therapies or hyperbaric oxygen treatment, may have a limited role in patients in whom revascularization procedures have failed or for those in whom revascularization is not technically possible--particularly when amputation is the only alternative. Prostanoids are the best-studied class of drugs for such applications, but their use is still investigational in the United States. Though other medical approaches, such as use of other vasoactive agents, drugs that treat claudication, or gene-induced angiogenesis may prove useful, they do not yet have demonstrated roles in the treatment of patients with CLI.

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“…Most vein graft stenoses remain asymptomatic until they cause complete graft occlusion [14]. A number of studies have shown that revision of failing saphenous vein grafts results in excellent long-term graft function, with assisted primary patencies of 82-92% at 5 years [15,16]. Once complete occlusion has occurred, secondary patencies after thrombectomy and revision are markedly worse at only 43-76% at 5 years [17][18][19].…”

Section: Femorodistal Reconstructionmentioning

confidence: 99%

The role of vein grafts in peripheral vascular disease and carotid artery disease

Walter

Magometschnigg

2007

Eur Surg

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Die Rolle von autologen Venegrafts in derChirurgie der peripheren Verschlußkrankheit und der Karotisstenose Zusammenfassung. Grundlagen: Die periphere Bypasschirurgie hat sich zu einer weit verbreiteten und erfolgreichen Behandlungsform fü r Patienten mit peripherer arterieller Verschlußkrankheit entwickelt.Methodik: Review der Fachliteratur. Ergebnisse: Obwohl Kunststoffprothesen als BypassGrafts stä ndig weiterentwickelt und verbessert werden, sind Venenbypass-Grafts nach wie vor unü bertroffen in Bezug auf ihre Sicherheit und Offenheitsraten. Um einen Langzeiterfolg fü r den Patienten zu gewä hrleisten, sind regelmä ßige Kontrollen und begleitende medikamentö se Therapie wichtig.Die Carotis-Thrombendarterektomie ist eine gut untersuchte und hä ufig durchgefü hrte Operation zur Reduzierung des Schlaganfallrisikos bei Carotisstenosen. Nach wie vor herrscht Diskussion ü ber das optimale Patchmaterial fü r den Verschluß der Arteriotomie. Aktuelle Meta-Analysen scheinen jedoch zu belegen, daß lediglich sehr kleine, wenn ü berhaupt, Unterschiede zwischen Venen-und Kunststoffpatches bestehen.Schlussfolgerungen: Trotz Verbesserungen der synthetischen Gefä ßersatz-Materialien sind autologe Venengrafts nach wie vor in der modernen Gefä ßchirurgie unverzichtbar.

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Surgical treatment of threatened reversed infrainguinal vein grafts

Cited by 63 publications

References 29 publications

Single-Center Experience in Endovascular Treatment for Infrainguinal Bypass Obstructions

Single-Center Experience in Endovascular Treatment for Infrainguinal Bypass Obstructions

Critical limb ischemia

The role of vein grafts in peripheral vascular disease and carotid artery disease

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