Document Detail


Balloon angioplasty as the primary treatment for failing infra-inguinal vein grafts.
MedLine Citation:
PMID:  19046905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We sought to evaluate the role of balloon angioplasty as the primary modality in the management of vein graft stenoses. METHODS: Patients who underwent infrainguinal vein graft bypass from January 2002 to December 2007 were enrolled into a surveillance program. Grafts which developed critical stenoses were identified and underwent urgent angiography with a view to angioplasty of the stenotic lesion. Lesions which were deemed unsuitable for angioplasty underwent urgent surgical repair. RESULTS: Four hundred and eleven grafts were followed up for a median of 19 months (range: 2-61). Ninety-six grafts (22.6%) developed critical stenosis. Twelve grafts occluded prior to repair and one was not intervened upon electively. Eight grafts underwent primary surgical repair. Seventy-six grafts underwent 99 endovascular procedures. Technical success was achieved in 60 grafts (78.9%). Of the grafts in which technical success had not been achieved, eight underwent repeat angioplasty and three were surgically repaired. Twenty-four grafts underwent repeat angioplasty for re-stenosis with a technical success rate of 71%. No difference was observed in graft patency (P=0.08) or amputation rates (P=0.32) between the grafts requiring intervention to maintain patency, and grafts which did not. Smoking [OR: 2.61 (95% CI: 1.51-4.53), (P=0.006)], diabetes [OR: 2.55 (95% CI: 1.49-4.35), (P=0.006)], renal failure [OR: 1.89 (95% CI: 1.19-3.38), (P=0.040)] and recurrent stenosis [OR: 3.22 (95% CI: 1.63-4.69), (P<0.001)] were risk factors for graft occlusion. CONCLUSIONS: Balloon angioplasty of failing infrainguinal vein bypass grafts is safe and can be performed with an acceptable medium term patency rate, albeit with a significant risk of re-stenosis which can be successfully treated in most patients using repeat endovascular intervention.
Authors:
R Mofidi; M Flett; J Nagy; R Ross; G D Griffiths; S Chakraverty; P A Stonebridge
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Publication Detail:
Type:  Journal Article     Date:  2008-11-28
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  37     ISSN:  1532-2165     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-27     Completed Date:  2009-02-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  198-205     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery and Radiology, Ninewells Hospital, Dundee, United Kingdom. rmofidi@doctors.net.uk
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Amputation
Angiography, Digital Subtraction
Angioplasty, Balloon*
Constriction, Pathologic
Diabetes Complications / etiology,  therapy
Female
Graft Occlusion, Vascular / etiology,  pathology,  surgery,  therapy*
Humans
Kidney Failure / complications
Male
Middle Aged
Odds Ratio
Recurrence
Reoperation
Risk Assessment
Risk Factors
Saphenous Vein / transplantation*
Smoking / adverse effects
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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