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International Angiology 2000 September;19(3):255-258

Copyright © 2001 EDIZIONI MINERVA MEDICA

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


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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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