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Single-center experience in endovascular treatment for infrainguinal bypass obstructions.
MedLine Citation:
PMID:  22840804     Owner:  NLM     Status:  In-Data-Review    
PURPOSE: To evaluate patency and clinical efficacy of endovascular therapy for infrainguinal bypass obstructions.
MATERIALS AND METHODS: Patients were categorized with regard to symptoms (asymptomatic/intermittent claudication [IC] vs critical limb ischemia [CLI]), bypass graft material used (autologous vs prosthetic graft), and localization of distal anastomoses (femoropopliteal vs femorodistal bypass). Primary patency was defined as absence of sonographically verified stenosis greater than 50%. Assisted primary patency was applied to secondary revisions to prevent impending occlusion. Secondary patency refers to repeat interventions aimed at restoring bypass patency after occlusion. Primary sustained clinical improvement in IC was defined as an upward shift of at least one category per Rutherford classification, accordingly to a level of claudication in patients with CLI.
RESULTS: A total of 54 patients (54 limbs, 12 with CLI) were included. At 1 year, primary patency rates were 74% in IC and 27% in CLI (P = .001), primary assisted patency rates were 85% in IC and 68% in CLI (P = .05), and secondary patency rates were 89% in IC and 100% in CLI (P = .32). Accordingly, primary sustained clinical improvement rates were 64% in IC and 25% in CLI (P = .018). After adjustment for confounding factors, CLI (hazard ratio [HR], 7.8; 95% CI, 2.3-26.32; P = .001) and impaired patent runoff (ie, less than three crural runoff vessels; HR, 0.16; 95% CI, 0.03-0.96; P = .045) were independently associated with impaired primary patency.
CONCLUSIONS: Endovascular revascularization is a reasonable treatment option to prevent impending bypass occlusion. Presence of CLI and impaired crural runoff are independent risk factors for lower patency rates.
Frederic Baumann; Rolf P Engelberger; Vladimir Makaloski; Dai-Do Do; Iris Baumgartner; Nicolas Diehm
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular and interventional radiology : JVIR     Volume:  23     ISSN:  1535-7732     ISO Abbreviation:  J Vasc Interv Radiol     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203369     Medline TA:  J Vasc Interv Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1055-62     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.
Department of General Internal Medicine, Inselspital, University Hospital of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland; Division of Clinical and Interventional Angiology, Swiss Cardiovascular Center, Inselspital, University Hospital of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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