Treatment of anastomotic stenoses of peripheral bypass grafts with cutting balloon angioplasty.
OBJECTIVE
The aim of this study was to assess the efficacy of cutting-balloon angioplasty (CBA) in the treatment of anastomotic stenoses of peripheral arterial bypass grafts.


METHODS
Seventeen patients (12 men and five women; age range 54-79 years, mean age 66.5) with stenosis or occlusion at the proximal or distal anastomoses of peripheral bypass grafts were treated with CBA. The diagnosis of stenosis was based on clinical and colour-Doppler ultrasound findings and confirmed by angiography with measurement of the intraluminal transstenotic pressure gradients. The diameter of the selected cutting balloon was 1-mm smaller than the vessel distal to the anastomosis and, in the event of suboptimal outcome, the procedure was completed with repeat dilatation with a larger standard balloon (+1 mm).


RESULTS
Technical success was obtained in 100% of cases. In three patients, CBA was performed after locoregional thrombolysis. No patient required stent placement or emergency surgery due to the presence of residual stenosis, suboptimal outcome or dissection. No complication occurred either during or after the procedure. During a mean follow-up period of 10.4 months (range 5-21 months), two restenoses developed at 9 and 7 months, which were treated with the same technique; in one patient with recurrent bypass occlusion at 5 months, a new bypass was created surgically owing to contraindications for locoregional thrombolysis. Cumulative primary patency at 12 and 18 months was 82.35%, whereas the two cases of restenoses treated with repeat CBA underwent further follow-up at 10 and 7 months, respectively.


CONCLUSIONS
Our data confirm the efficacy of CBA in the treatment of anastomotic stenoses of peripheral arterial bypass grafts.
Department of Diagnostic and Interventional Radiology, Ospedale Ferrarotto, Via Trieste 14, 95127 Catania, Italy. antodoc@yahoo.com
A
A
Basile
D
D
Tsetis
G
G
Chlouverakis
G
G
Calcara
G
G
Ardita
G
G
Giulietti
M
M
Di Salvo
A
A
Granata
T
T
Lupattelli
M T
MT
Patti
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014680:Veins / Q000637:transplantation