Lysis/balloon angioplasty versus thrombectomy/ open patch angioplasty of failed femoropopliteal polytetrafluoroethylene bypass grafts.
OBJECTIVE
Several studies have reported on the outcome of lysis/percutaneous transluminal balloon angioplasty (PTA) of failed or failing femoropopliteal bypass grafts (FPGs) with mixed results. None of these studies have compared the results of lysis/PTA versus thrombectomy/open patch repair for failed above-knee polytetrafluoroethylene (PTFE) FPGs.


METHODS
Patients with failed (thrombosed) above-knee FPGs (PTFE, Goretex) during a 10-year period were given the option to choose between thrombectomy/open patch repair for localized anastomotic short stenosis (less-than-or-equal2 cm; group A, 31 patients) and lysis/PTA or thrombectomy/balloon angioplasty when lysis failed or was contraindicated (group B, 26 patients). The cumulative patency rates were compared by using a Kaplan-Meier life table analysis. All patients underwent routine color duplex ultrasound scanning/ankle brachial index measurements at 30 days, 6 months, and every 6 months thereafter.


RESULTS
Demographic and clinical characteristics and indications for intervention were comparable in both groups. The mean follow-up period was 54.1 and 46.2 months in group A and group B, respectively. There were four perioperative complications in group A (13%) and seven perioperative complications in group B (27%). Initial technical success and 30-day secondary graft patency rates were 100% in both groups. Overall, 17 of 31 patients (55%) had open grafts, with no further revisions in group A and six of 26 patients (23%) in group B requiring further revisions (P =.012). Nine of 31 grafts (29%) failed in group A versus 15 of 26 grafts (58%) in group B (P =.027). The rate of limb loss was comparable in both groups (6% vs 12%). The overall cumulative secondary patency rates at 6 months and 1, 2, 3, 4, and 5 years were 100%, 93%, 85%, 72%, 67%, and 62% for group A and 100%, 96%, 88%, 76%, 63%, and 45% for group B (P =.035). Thirty-five further interventions were needed to maintain graft patency in group B (mean, 1.35; range, 0-3) versus five further interventions in group A (mean, 0.16; range, 0-1; P <.05).


CONCLUSIONS
Thrombectomy/open surgical repair is superior to lysis/PTA (or thrombectomy/balloon angioplasty) for the treatment of failed above-knee PTFE FPGs with anastomotic stenoses. Therefore, balloon angioplasty should be reserved for patients who are at high risk for surgery.
Aburahma
Ali F
AF
Department of Surgery, Robert C. Byrd Health Sciences Center of West Virginia University, Charleston, USA.
Hopkins
Eric S
ES
Wulu
John T
JT
Cook
Chris C
CC
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D003131:Combined Modality Therapy; D005121:Extremities / Q000098:blood supply* / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000637:transplantation*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000628:therapy; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000628:therapy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D011150:Popliteal Artery / Q000637:transplantation*; D012501:Saphenous Vein / Q000637:transplantation; D012720:Severity of Illness Index; D017131:Thrombectomy; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency / Q000502:physiology
D011138:Polytetrafluoroethylene