Document Detail


Balloon angioplasty as a treatment of failing infrainguinal autologous vein bypass grafts.
MedLine Citation:
PMID:  14743147     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The purpose of this study was to evaluate the role of balloon angioplasty in the treatment of failing infrainguinal vein bypass (IVB) grafts.
METHODS: A retrospective chart review of patients undergoing revision of a failing IVB graft by vascular surgeons at a tertiary care center from 1990 to 2001 was performed. Failing bypass grafts were identified by routine duplex scan surveillance and physical examination. The criteria for endovascular intervention varied on the basis of surgeon preferences and time period; factors considered when choosing balloon angioplasty included significant comorbidities that precluded operative intervention, the lack of adequate conduit for surgical revision, or poor accessibility of the stenotic lesion. Data recorded included demographic patient data, type of IVB graft, patency status, further procedures performed, and all complications and mortalities. Cumulative primary and assisted patency rates were calculated by using Kaplan-Meier life-table analysis.
RESULTS: A total of 45 balloon angioplasties were performed in 36 patients. There were 36 angioplasties of vein bypass grafts, and additional balloon angioplasties were performed on nine of these patients. Locations of IVB grafts included femoropopliteal (13 patients), femorodistal (13), and popliteal to distal (10). Initial success was achieved in 33 of 36 vein bypass grafts (91.7%). In these bypass grafts, the stenotic lesions were identified and treated at the proximal anastomosis (3 patients), mid-bypass graft (6 patients), and distal anastomosis (27 patients). Autogenous vein was used for all bypass grafts. Cumulative vein bypass graft (life-table analysis) primary patency rates (those free of occlusion or bypass graft threatening stenosis) were 74.2% at 6 months, 62.7% at 12 months, and 58.2% at 24 months. Repeat interventions included surgical thrombectomy with vein patch angioplasty or bypass graft revision, as well as repeat balloon angioplasty with or without thrombolysis. Cumulative assisted vein bypass graft patency rates (those free of occlusion or bypass graft threatening stenosis) were 87.0%, 83.2%, and 78.9% at 6, 12, and 24 months, respectively. Two patients (4%) developed thigh hematomas; no other procedure-related complications were noted, and there were no deaths in the perioperative period.
CONCLUSION: Balloon angioplasty of failing infrainguinal vein bypass grafts can be successfully performed with a low rate of complications. Acceptable short-term patency can be achieved. This procedure should be considered as an initial option in failing IVB grafts.
Authors:
Gregory A Carlson; Jamal J Hoballah; William J Sharp; Mario Martinasevic; Kerri Maiers Yelden; John D Corson; Timothy F Kresowik
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  39     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-01-26     Completed Date:  2004-02-19     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  421-6     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1086, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon*
Arteriovenous Shunt, Surgical
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation
Female
Graft Occlusion, Vascular / therapy*
Humans
Life Tables
Male
Postoperative Complications / therapy*
Prosthesis Failure*
Retrospective Studies
Time Factors
Vascular Patency

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


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