title: Management of failing prosthetic bypass grafts with metallic stent placement.
abstract: 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.
authors.affiliation: Institute for Vascular Health and Disease, Albany Medical College, A-113, 47 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: G P
authors.initials: GP
authors.lastname: Siskin
authors.forename: B F
authors.initials: BF
authors.lastname: Stainken
authors.forename: V S
authors.initials: VS
authors.lastname: Mandell
authors.forename: R C
authors.initials: RC
authors.lastname: Darling
authors.forename: K
authors.initials: K
authors.lastname: Dowling
authors.forename: A
authors.initials: A
authors.lastname: Herr
mesh_terms: 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