Balloon Angioplasty as the Primary Treatment for Failing Infra-inguinal Vein Grafts

TY - JOUR

T1 - Balloon Angioplasty as the Primary Treatment for Failing Infra-inguinal Vein Grafts

AU - Mofidi, R.

AU - Flett, M.

AU - Nagy, J.

AU - Ross, R.

AU - Griffiths, G. D.

AU - Chakraverty, S.

AU - Stonebridge, P. A.

PY - 2009/2

Y1 - 2009/2

N2 - 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. (C) 2008 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery.

AB - 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. (C) 2008 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery.

KW - Vein graft

KW - Stenosis

KW - Angioplasty

KW - Surveillance

KW - PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY

KW - DUPLEX SCAN SURVEILLANCE

KW - CUTTING-BALLOON

KW - BYPASS GRAFTS

KW - ENDOVASCULAR INTERVENTION

KW - HEMODIALYSIS FISTULA

KW - STENOSIS

KW - REVISION

KW - RUPTURE

KW - ISCHEMIA

U2 - 10.1016/j.ejvs.2008.10.018

DO - 10.1016/j.ejvs.2008.10.018

M3 - Article

C2 - 19046905

SN - 1078-5884

VL - 37

SP - 198

EP - 205

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

IS - 2

ER -