Percutaneous transluminal angioplasty of peripheral bypass stenoses.
OBJECTIVE
To assess the success of percutaneous transluminal angioplasty (PTA) in treating peripheral bypass stenoses.


METHODS
Patients who received a femoropopliteal or femorocrural bypass graft for limb ischemia were included in a duplex surveillance program. If duplex ultrasound revealed a short (<2 cm) severe (peak systolic velocity ratio >/= 4.5) stenosis, patients were scheduled for arteriography and PTA. Fifty-eight peripheral bypass stenoses in 39 grafts in 37 patients were treated with PTA. The cumulative primary patency of treated stenoses was calculated.


RESULTS
During the first year after PTA 31 (53%) treated lesions remained patent, 15 (26%) lesions restenosed at a median interval of 5.0 (range 1-12) months and 4 (7%) bypasses occluded. The cumulative primary patency of 58 treated graft stenoses at 1 year was 60% [95% confidence interval (CI) 46%-74%] and 55% (95% CI 41%-70%) at 2 years. Graft body stenoses showed a better 2-year cumulative primary patency (86%; 95% CI 68%-100%) compared with juxta-anastomotic lesions (45%; 95% CI 29%-62%; p < 0.05).


CONCLUSIONS
PTA is justifiable as the initial treatment of peripheral bypass stenoses. Nevertheless, the restenosis rate is rather high, especially in juxta-anastomotic lesions. Continuation of duplex surveillance after PTA and timely reintervention is recommended.
Department of Vascular Surgery, G1-244, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
A W
AW
Hoksbergen
D A
DA
Legemate
J A
JA
Reekers
D T
DT
Ubbink
M J
MJ
Jacobs
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods; D001783:Blood Flow Velocity; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex