ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 2000 June;7(2):115-24

Copyright © 2001 EDIZIONI MINERVA MEDICA

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.