Treatment of anastomotic bypass graft stenosis with directional atherectomy: short-term and intermediate-term results.
OBJECTIVE
Areas of anastomotic stenosis in lower-extremity bypass grafts (BPGs) were treated by means of directional atherectomy (DA) in hopes of achieving better patency rates than have been reported with percutaneous transluminal angioplasty (PTA).


METHODS
During a 4-year period, 17 patients (11 men and six women) with 23 areas of anastomotic stenosis in 18 lower-extremity BPGs were selected for treatment with DA. Urokinase thrombolysis was initially performed in eight BPGs that were thrombosed at the time of presentation. Adjunctive preatherectomy PTA was performed in six lesions, and postatherectomy PTA was performed in three lesions.


RESULTS
The technical success rate for DA was 92% (23 of 25 sites). There was less than 50% restenosis at 74% of the areas of stenosis (14 of 19 sites), with a mean follow-up time for the sites of 13 months. The graft patency rate was 88% (14 of 16 grafts), with a mean follow-up time for the grafts of 14 months. Areas of stenosis treated with DA alone had the same patency rates as those treated with DA and PTA.


CONCLUSIONS
DA is an effective treatment method for anastomotic peripheral arterial BPG stenosis. The intermediate-term patency rates following DA are superior to those reported for PTA and similar to those reported for surgical revision.
Dolmatch
B L
BL
Department of Radiology, Washington Hospital Center, Washington, DC, USA.
Gray
R J
RJ
Horton
K M
KM
Rundback
J H
JH
Kline
M E
ME
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D000800:Angioplasty, Balloon; D017073:Atherectomy; D001807:Blood Vessel Prosthesis; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000601:surgery / Q000628:therapy; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000601:surgery*; D012008:Recurrence; D012501:Saphenous Vein / Q000637:transplantation; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency
D011138:Polytetrafluoroethylene; D014568:Urokinase-Type Plasminogen Activator