Management of failing prosthetic bypass grafts with metallic stent placement.
OBJECTIVE
To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts.


METHODS
Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n = 3), rest pain (n = 9), and minor or major tissue loss (n = 3). Lesions were at the proximal anastomosis (n = 6), the distal anastomosis (n = 3), or within the graft (n = 6).


RESULTS
Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement (at a mean of 10.8 months). Three late deaths occurred during follow-up.


CONCLUSIONS
Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.
Siskin
G P
GP
Institute for Vascular Health and Disease, Albany Medical College, A-113, 47 New Scotland Avenue, Albany, NY 12208, USA.
Stainken
B F
BF
Mandell
V S
VS
Darling
R C
RC
Dowling
K
K
Herr
A
A
D000328:Adult; D000368:Aged; D000792:Angiography; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency