[Angioplasty of the distal anastomosis und runoff arteries of occluded infrainguinal bypasses].
BACKGROUND
We investigated the clinical results of transluminal angioplasty performed through infrainguinal bypass grafts for stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in high risk patients and the influence of different parameters on limb salvage, primary and secondary patency rate.


METHODS
Between January 2001 and March 2005 we performed 49 transluminal angioplasties on stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in 49 (16 female, 23 male, mean age 71.1 years) patients with occluded infrainguinal bypass. 20 angioplasties occurred in the runoff arteries, 5 at the distal anastomosis and 24 at both locations at a median of 11.3 months (range 2-85 months) after infrainguinal bypass grafting). 20 procedures were on popliteal artery above the knee, 21 below the knee and 8 on crural arteries.


RESULTS
Kaplan-Meier analysis showed a cumulative limb salvage of 87.6 and 76.4 % after 6 months and two years, respectively. Patients with gangrenous lesions had a 5 times higher risk of amputation (Cox-regression model). Primary and secondary patency rates were at 6 months 85.1 and 91.1 % respectively and were at one year 73.3 and 78.8 % respectively. Patients with end stage renal disease were in 4 times hazard to primary occlusion and patients with gangrenous lesions 5 times to secondary occlusion (Cox-regression model).


CONCLUSIONS
Even if the long-term results of angioplasty on stenotic or occluded lesions at the distal anastomosis and/or in the runoff arteries are inferior to the results of surgical revisions reported in literature, angioplasty in high risk patients with absence af a vein may be the first line alternative intervention for limb salvage.
Sigala
F
F
Kplus Gefässzentrum Haan, Vaskuläre und Endovaskuläre Chirurgie, St. Josef Krankenhaus Haan GmbH, Robert-Koch-Strasse 16, 42781 Haan.
Baunach
C
C
Menenakos
C
C
Langer
S
S
Sigalas
P
P
Triadafyllou
A
A
Sigalas
K
K
Papalambros
E
E
Bramis
J
J
Hepp
W
W
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000714:Anastomosis, Surgical; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D005734:Gangrene; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012086:Reoperation; D018570:Risk Assessment; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology