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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2000 June;7(2):115-24
language: English, Italian
Endovascular treatment of distal anastomotic stenoses in infrainguinal bypasses
Domanin M., Costantini A., Gabrielli L., Lorenzi G., Molinari A., Crippa M., Agrifoglio G.
From the Institute of Vascular Surgery and Angiology Milan University, Milan, Italy
Aim. The late complication that most frequently leads to the failure of infrainguinal bypass surgery consists of thrombosis caused by myointimal hyperplasia phenomena at the level of the distal anastomosis or following the evolution of atherosclerotic disease. Endovascular surgery is indicated for the correction of these lesions owing to the complexity of redo surgery at this level.
Methods. A comparative retrospective study was made of 20 patients undergoing distal anastomosis PTA after thrombectomy of the infrainguinal bypass during the period January 1989/March 1999. In 12 cases surgery was performed at the level of the supragenicular segment (11 with alloplastic bypasses, 1 with vein graft bypass) and 8 at the level of the infragenicular segment (1 with alloplastic bypass and 7 using the saphenous vein). A stent was used in 5 cases of alloplastic bypass.
Results. Statistical analyses using the Kaplan-Meyer test showed total immediate patency in 75%, and 48.7% at 36 months, with limb salvage in 95% and 83.3%, respectively. In particular, in the supragenicular district, primary patency and at 36 months was 75% and 37.5% versus 75% and 62.5% in the infragenicular district.
Conclusions. The results of the endovascular procedures performed as redo surgery may be less efficacious in terms of patency compared to primary procedures. However, in view of the technical difficulties correlated with redo surgery, these results should be considered satisfactory, above all in terms of limb salvage.