Angioplasty of distal venous bypasses: is it worth the cost?
Saphenous vein is the best graft for long term patency infragenicular bypass. During follow-up, stenoses can appear on the graft. Is angioplasty a good solution for the treatment of these lesions? During the follow-up of 612 saphenous bypass with below-knee distal anastomosis, 90 stenoses (over 70%) were discovered. Among them 36 were treated with transluminal angioplasty (34 bypasses). Stenoses were detected at a mean follow-up of 7 months after bypass realization. They were located 17 times on the graft itself and 19 times near the anastomoses and they were never longer than 5 cm. Percutaneous approach was preferred for 11 cases and surgical for the others. Immediate success was obtained in 33 cases (91%). Among the 3 failed cases 2 needed a new bypass. Mean follow-up was 33 months after the initial bypass and 24 months after angioplasty. Graft patency was ensured by a single angioplasty in 18 cases. Assisted primary patency, cumulative patency, limb salvage rate were respectively 65%, 91%, 100% at one year and 53%, 72%, 96% at 2 years. Transluminal angioplasty can be advised for the treatment of short stenosis of infrainguinal vein graft: this technique has a weak risk, little surgical aggressiveness, short hospitalisation. Results are acceptable and not very different with the location of the stenosis.
Favre
J P
JP
Service of Cardio-Vascular Surgery, Hopital Nord, Saint-Etienne, France.
Malouki
I
I
Sobhy
M
M
Gay
J L
JL
Gournier
J P
JP
Barral
X
X
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000191:economics; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000637:transplantation*; D014654:Vascular Patency