Infrainguinal vein graft stenosis: cutting balloon angioplasty as the first-line treatment of choice.
OBJECTIVE
The optimal treatment for hemodynamically significant infrainguinal vein bypass graft stenosis is not known. This study compares three options as first choice for the revision of failing infrainguinal vein grafts: cutting balloon angioplasty (CBA), standard percutaneous transluminal balloon angioplasty (PTA), and open surgical revision (OS).


METHODS
Infrainguinal vein bypass graft lesions treated in a single institution during a 12-year period were evaluated. Of these, 161 lesions in 124 infrainguinal bypasses (101 patients) were treated with OS (n = 42), PTA (n = 57), or CBA (n = 62). The initial indication for the bypass in these patients was limb salvage in 73% and claudication in 27%. The primary outcome of interest was the development of vein graft occlusion or significant stenosis (>or=70%) as detected by surveillance duplex ultrasound scanning or arteriography some time after repair.


RESULTS
The stenosis-free patency rates at 48 months for OS, CBA, and PTA were 74%, 62%, and 34%, respectively. PTA was associated with an increased risk of treatment failure compared with both OS (hazard ratio [HR], 3.9; P < .0001) and CBA (HR, 3.1; P < .0001). There was no significant difference between OS and CBA (HR, 1.3 for CBA vs OS, P = .6). Pseudoaneurysms developed in two CBA patients. One ruptured and required interposition graft, and one was monitored.


CONCLUSIONS
Cutting balloon angioplasty is a reasonable, initial treatment for infrainguinal vein graft stenosis in most patients. It is a safe, minimally invasive, outpatient procedure with patency rates that are comparable to OS and superior to PTA.
Schneider
Peter A
PA
Division of Vascular Therapy, Hawaii Permanente Medical Group, Honolulu, Hawaii 96819, USA. peter.schneider@kp.org
Caps
Michael T
MT
Nelken
Nicolas
N
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D003251:Constriction, Pathologic; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007511:Ischemia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012501:Saphenous Vein / Q000637:transplantation*; D017211:Treatment Failure; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects