| Infrainguinal vein graft stenosis: cutting balloon angioplasty as the first-line treatment of choice. | |
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MedLine Citation:
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PMID: 18372146 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Peter A Schneider; Michael T Caps; Nicolas Nelken |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2008-04-18 |
Journal Detail:
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Title: Journal of vascular surgery Volume: 47 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-05-05 Completed Date: 2008-06-12 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 960-6; discussion 966 Citation Subset: IM |
Affiliation:
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Division of Vascular Therapy, Hawaii Permanente Medical Group, Honolulu, Hawaii 96819, USA. peter.schneider@kp.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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