title: Outcome of endovascular reintervention for significant stenosis at infrainguinal bypass anastomoses.
abstract: OBJECTIVE
  The durability of an infrainguinal bypass may be hampered by development of stenosis at the anastomoses. We describe the patency of percutaneous transluminal angioplasty (PTA) of these anastomotic stenoses.
  
  
  METHODS
  Any venous or prosthetic infrainguinal bypass with a hemodynamically significant anastomotic stenosis, symptomatic or asymptomatic, was considered a bypass at risk (BAR) for occlusion. All BARs undergoing PTA in two large vascular referral centers between January 2005 and December 2010 were retrospectively reviewed. Procedural success was defined as <30% residual stenosis. Primary end points were primary, assisted primary, and secondary patency rates.
  
  
  RESULTS
  Included were 43 patients with 43 BARs (31 venous, 11 prosthetic, and 1 unknown conduit; 19 supragenicular and 24 infragenicular). Mean follow-up was 17 months (range, 0-57 months). Procedures constituted 48 interventions for proximal (n = 13), distal (n = 25), or combined (n = 5) anastomotic stenoses. Procedural success was 96%. The primary, assisted primary, and secondary patency rates were 58%, 85%, and 88%, respectively, at 2 years.
  
  
  CONCLUSIONS
  PTA for infrainguinal BAR due to anastomotic stenosis is technically feasible with acceptable durability. PTA for these anastomotic stenoses may be considered a safe option as the first-line treatment.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: van Oostenbrugge
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jean-Paul P M
authors.initials: JP
authors.lastname: de Vries
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Berger
authors.affiliation: Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jan Albert
authors.initials: JA
authors.lastname: Vos
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Evert P A
authors.initials: EP
authors.lastname: Vonken
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: g.j.deborst-2@umcutrecht.nl.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: de Borst
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000637:transplantation*