Document Detail


Infrainguinal vein graft stenosis: cutting balloon angioplasty as the first-line treatment of choice.
MedLine Citation:
PMID:  18372146     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The optimal treatment for hemodynamically significant infrainguinal vein bypass graft stenosis is not known. This study compares three options as first choice for the revision of failing infrainguinal vein grafts: cutting balloon angioplasty (CBA), standard percutaneous transluminal balloon angioplasty (PTA), and open surgical revision (OS).
METHODS: Infrainguinal vein bypass graft lesions treated in a single institution during a 12-year period were evaluated. Of these, 161 lesions in 124 infrainguinal bypasses (101 patients) were treated with OS (n = 42), PTA (n = 57), or CBA (n = 62). The initial indication for the bypass in these patients was limb salvage in 73% and claudication in 27%. The primary outcome of interest was the development of vein graft occlusion or significant stenosis (>or=70%) as detected by surveillance duplex ultrasound scanning or arteriography some time after repair.
RESULTS: The stenosis-free patency rates at 48 months for OS, CBA, and PTA were 74%, 62%, and 34%, respectively. PTA was associated with an increased risk of treatment failure compared with both OS (hazard ratio [HR], 3.9; P < .0001) and CBA (HR, 3.1; P < .0001). There was no significant difference between OS and CBA (HR, 1.3 for CBA vs OS, P = .6). Pseudoaneurysms developed in two CBA patients. One ruptured and required interposition graft, and one was monitored.
CONCLUSION: Cutting balloon angioplasty is a reasonable, initial treatment for infrainguinal vein graft stenosis in most patients. It is a safe, minimally invasive, outpatient procedure with patency rates that are comparable to OS and superior to PTA.
Authors:
Peter A Schneider; Michael T Caps; Nicolas Nelken
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-04-18
Journal Detail:
Title:  Journal of vascular surgery     Volume:  47     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-05     Completed Date:  2008-06-12     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:  960-6; discussion 966     Citation Subset:  IM    
Affiliation:
Division of Vascular Therapy, Hawaii Permanente Medical Group, Honolulu, Hawaii 96819, USA. peter.schneider@kp.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angiography
Angioplasty, Balloon* / adverse effects,  methods
Constriction, Pathologic
Graft Occlusion, Vascular / etiology,  pathology,  physiopathology,  surgery,  therapy*
Humans
Ischemia / pathology,  physiopathology,  surgery*
Lower Extremity / blood supply*
Male
Middle Aged
Odds Ratio
Patient Selection*
Retrospective Studies
Risk Assessment
Saphenous Vein / transplantation*
Treatment Failure
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency
Vascular Surgical Procedures* / adverse effects

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


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