title: Cutting balloon percutaneous transluminal angioplasty for salvage of lower limb arterial bypass grafts: feasibility.
abstract: OBJECTIVE
  To evaluate the feasibility of cutting balloon percutaneous transluminal angioplasty (PTA) for treatment of neointimal hyperplasia in peripheral arterial bypass grafts.
  
  
  METHODS
  Fifteen consecutive patients (six women, nine men; age range, 57-89 years; mean age, 71 years) were treated with cutting balloon PTA for 16 anastomotic stenoses after infrainguinal bypass (prosthetic grafts, seven patients; prosthetic-vein composite grafts, two; venous grafts, five; and ileofemoral stent-graft, one). Cutting balloon PTA was followed by conventional PTA to improve anastomotic diameter. Patients with stenotic vein grafts underwent cutting balloon PTA after failed conventional PTA; the other patients were treated primarily with cutting balloon PTA. Criteria for success were a lumen diameter improvement of greater than 50% or residual stenosis of 20% or less. Follow-up was performed with color duplex ultrasonographic surveillance. Patency rates and durations were calculated with Kaplan-Meier survival curves and log-rank statistics.
  
  
  RESULTS
  Attempted conventional PTA (n = 6) prior to cutting balloon PTA was unsuccessful. Cutting balloon PTA was technically successful in 15 (94%) of 16 lesions, without clinical complications. Two local restenoses and one graft occlusion occurred between 5 and 7 months. The cumulative 6-month primary and secondary graft patency rates were 84% and 92%, respectively. At 12 and 18 months, they were 67% (95% CI: 0.34, 0.86) and 83% (95% CI: 0.48, 0.96), respectively; mean follow-up was 10.0 months.
  
  
  CONCLUSIONS
  Cutting balloon PTA proved feasible for treatment of resistant peripheral arterial bypass graft stenosis, commonly caused by neointimal hyperplasia, with excellent technical success. Short-term patency with this technique appears to be superior to that with conventional PTA, and it compares well with patency of atherectomy for salvage of infrainguinal bypass grafts.
authors.affiliation: Department of Diagnostic Radiology, St George's Hospital, London, England. cengelke@hotmail.com
authors.forename: Christoph
authors.initials: C
authors.lastname: Engelke
authors.forename: Robert A
authors.initials: RA
authors.lastname: Morgan
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Belli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies