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A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Italian Journal of Vascular and Endovascular Surgery 2004 March;11(1):13-7

language: English

Patency of infrainguinal bypass grafts after endovascular treatment of distal anastomotic steno-obstructive lesions

Costantini A., Domanin M., Crippa M., Molinari A, ARolli A., Gotti A., Agrifoglio G.

Department of Vascular Surgery and Angiology University of Milan, Milan, Italy


Aim. Thrombosis is the ­most com­mon com­pli­ca­tion of infra­in­gui­nal ­bypass ­graft pro­ce­dures, the ­main fac­tors ­being myoin­ti­mal hyper­pla­sia at the lev­el of the dis­tal anas­tom­o­sis or the devel­op­ment of ath­ero­scler­o­sis. Owing to the com­plex­ity of ­redo sur­gery at ­this ­site, endo­vas­cu­lar tech­niques are indi­cat­ed for the ­repair of ­these ­lesions.
Methods. From January 1999 to June 2001, a ­total of 19 ­patients ­received 20 com­bined inter­ven­tions of infra­in­gui­nal ­bypass throm­bec­to­my and endo­vas­cu­lar treat­ment of dis­tal anas­to­mot­ic sin­gle obstruc­tive ­lesions (1.5-2 cm in ­length). Percuta-neous trans­lu­mi­nal angio­plas­ty (PTA) was per­formed in 11 allo­plas­tic femo­ro-pop­li­teal ­bypass ­grafts and in 9 saph­e­nous ­vein ­below-­knee ­bypass ­grafts (6 femo­ro-pop­li­teal, 2 femo­ro-pos­te­ri­or tibi­al, 1 femo­ro-per­oneal ­bypass ­graft). Stenting was per­formed in 8 cas­es of femo­ro-pop­li­teal ­bypass (72.7%) and in 6 cas­es of ­below-­knee ­bypass (66.6%).
Results. The Kaplan-Meyer ­test ­showed ­that the ear­ly and 36-­month paten­cy ­rates ­were 100% and 61.1%, respec­tive­ly, ­with a 95% ­limb sal­vage ­rate at 36 ­months (­only 1 ­thigh ampu­ta­tion 6 ­months ­after com­bined throm­bec­to­my and stent­ing of a femo­ro-per­oneal ­bypass). In the ­above-­knee and ­below-­knee dis­tricts, 36-­month paten­cy ­rates ­were 55.5% and 66.6%, respec­tive­ly (p<0.7 NS). Moreover, 2 cas­es (25%) of ­above-­knee and 3 (50%) of ­below-­knee ­bypass obstruc­tion ­were ­observed ­after stent­ing of the dis­tal anas­tom­o­sis (p<0.7 NS). The ­time peri­od ­between the pri­mary and sec­on­dary oper­a­tions ­ranged ­from 2 to 84 ­months (aver­age, 13.8 ­months).
Conclusion. Primary paten­cy and ­limb sal­vage ­rates ­showed ­that, ­because of the tech­ni­cal dif­fi­cul­ties in oper­at­ing on an ­area ­with a ­high com­po­nent of ­scar tis­sue, endo­vas­cu­lar pro­ce­dures for the treat­ment of ­small, sin­gle anas­to­mot­ic ste­nos­es asso­ciat­ed ­with infra­in­gui­nal ­bypass throm­bo­sis may be con­sid­ered an effec­tive alter­na­tive to con­ven­tion­al ­redo sur­gery.

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