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Five-Years' Experience with Revision of Failing Peripheral Vein Bypasses

Katja C. Vogt, MD

Department of Vascular Surgery, Rigshospitalet, University Hospital, Copenhagen, Denmark

John Grønvall Rasmussen, MD

Departments of Radiology, Rigshospitalet, University Hospital, Copenhagen, Denmark

Torben V. Schroeder, DMSc

Department of Vascular Surgery, Rigshospitalet, University Hospital, Copenhagen, Denmark

The aim of this study was to assess the results of surgical and endovascular treatment of failing or failed infrainguinal vein bypasses. Eight hundred seventy-five patients with peripheral vein bypasses performed during a 5-year period were followed up prospectively by ankle blood pressure measurements and/or duplex scanning at 3, 6, 9, 12, 18, 24, 36, and 48 months. A total of 59 (7%) grafts required revision during the study period. Fifty-six juxtaanastomotic or intragraft stenoses in 46 failing but patent bypasses were electively revised. Thirty-one predominantly proximal and midgraft lesions in 28 grafts were treated surgically by patch angioplasty (n= 17), interposition/jump grafting (n= 10), or thromboendarterectomy (n= 4). Twenty-five predominantly distal stenoses in 18 grafts were treated by percutaneous transluminal balloon angioplasty (PTA). With this approach, surgery yielded a higher 12-month "primary" bypass patency after revision (72% vs 37%, P=0.02), a higher secondary patency (81% vs 48%, P=0.05) and a better limb survival (96% vs 64%, P=0.03) than PTA. Following thrombectomy (n=12) or thrombolysis (n= 1) of 13 occluded bypasses, a 6-month "primary" patency after revision of 31%, a secondary patency of 38%, and a limb survival of 61% were achieved. In conclusion surgical repair appears to be the most durable procedure in the management of threatened infrainguinal vein bypasses. PTA of distal vein graft lesions was associated with a high risk of restenosis and graft failure.

Vascular and Endovascular Surgery, Vol. 33, No. 1, 73-80 (1999)
DOI: 10.1177/153857449903300115


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