Long-term follow-up of management of failing in situ saphenous vein bypass grafts using endovascular intervention techniques.
OBJECTIVE
To report the long-term follow-up of previously reported cases of salvaging failing or failed in situ bypass grafts using endovascular techniques, to include previously unreported cases, and to include the results of thrombolysis for the salvage of occluded in situ venous bypass grafts.


METHODS
Between 1985 and 1995, 352 patients underwent distal bypass via the in situ saphenous vein. Seventy-three of these patients underwent endovascular interventions for (i) graft stenoses (65 lesions in 40 patients) treated by balloon angioplasty (PTA), (ii) AV residual fistulas to veins (AVF) (23 patients) occluded by coil embolotherapy, (iii) graft occlusion (21 occluded grafts in 19 patients) treated by catheter-directed high-dose thrombolytic infusion and PTA or surgical revision of uncovered stenoses, and (iv) retained valve leaflets causing stenoses (five patients) treated by valvectomy and/or PTA. Cumulative patency rates were determined by the Kaplan-Meier method. Twenty-nine of 73 patients had been previously reported by the authors.


RESULTS
PTA was successful in 39 of 40 patients, cumulative patency after bypass PTA was 0.79 (SE +/- 0.07) for 12 months and 0.63 (SE +/- 0.12) for 5 years. The only complication of PTA was a graft anastomotic disruption that was successfully treated by surgery. Longer lesions and lesions requiring repeated PTA were more likely to restenose. For thrombolysis, there were 13 of 19 successful infusions and five delayed occlusions. The cumulative patency for both 12 months and 5 years was 0.43 (SE +/- 0.12). AVF embolization was successful in 21 of 23 patients. Cumulative patency for 12 months and 5 years was 0.87 (SE +/- 0.07) and 0.81 (SE +/- 0.09), respectively. Five successful valvectomy procedures were performed by stripping residual valves with endocardial forceps.


CONCLUSIONS
In experienced hands, PTA and AVF embolization can be performed on failing in situ saphenous vein bypass grafts with good long-term patency. Thrombolysis results were less favorable but can prolong patency of grafts.
Goh
R H
RH
Department of Medical Imaging, The Toronto Hospital, Ontario, Canada.
Sniderman
K W
KW
Kalman
P G
PG
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007269:Injections, Intra-Arterial; 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; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D015912:Thrombolytic Therapy / Q000379:methods*
D005343:Fibrinolytic Agents