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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2000 September;19(3):255-258

lingua: Inglese

Patency after revision surgery for failing infrainguinal vein grafts

Sato O., Miyata T. *, Deguchi J. *, Kimura H., Kondoh K.

From the Department of Surgery, Saitama Medical Center, Kawagoe, Saitama, and the * Second Department of Surgery, University of Tokyo, Tokyo, Japan


Background. Although the ­results of ­bypass sur­gery on arter­ies in the lower extrem­ities have been great­ly ­improved dur­ing the last ­decades, there are still a sig­nif­i­cant num­ber of pri­mary fail­ures. In order to inves­ti­gate the rea­sons for the fail­ure of autog­e­nous vein ­grafts after infra­in­gui­nal arte­ri­al ­bypass sur­gery and to ascer­tain the ­results of revi­sion oper­a­tions on the fail­ing ­grafts, we con­duct­ed a clin­i­cal study.
Methods. Retrospective study on 104 ­patients who under­went infra­in­gui­nal arte­ri­al revas­cu­lar­isa­tion with autog­e­nous veins.
Results. One hun­dred and twen­ty-six bypass­es were con­struct­ed in 121 limbs. Seventy-nine of these were for claud­i­ca­tion and 47 for threat­ened limbs (rest pain or ischaem­ic tis­sue loss). Five-year pri­mary and sec­on­dary paten­cy rates were 69.7% and 84.9% respec­tive­ly. Spliced or ­suture-­repaired ­grafts had a poor out­come; five out of seven even­tu­al­ly becom­ing throm­bosed. On the other hand, revi­sion oper­a­tions for fail­ing but not yet throm­bosed ­grafts pro­duced good ­results; the five-year pri­mary paten­cy rate after these oper­a­tions was 76.0%, where­as after sin­gle-seg­ment pri­mary graft­ing it was 72.1%.
Conclusions. These ­results ­stress the impor­tance of vig­i­lant fol­low-up and ­active inter­ven­tion for fail­ing ­grafts. Poor out­come with ­injured vein ­grafts empha­siz­es the impor­tance of metic­u­lous vein har­vest­ing.

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