title: Endovascular therapy is effective treatment for focal stenoses in failing infrapopliteal vein grafts.
abstract: BACKGROUND
  To evaluate the efficacy of endovascular therapy for maintaining patency and preserving limbs among patients with failing infrapopliteal bypass grafts.
  
  
  METHODS
  We gathered data from a registry of catheter-based procedures for peripheral artery disease. Of 1554 arteriograms performed from 2006 to 2012, 30 patients had interventions for failing bypass vein grafts to infrapopliteal target vessels. The first intervention for each patient was used in this analysis. Duplex ultrasonography was used within 30 days after intervention and subsequently at 3- to 6-month intervals for graft surveillance.
  
  
  RESULTS
  Interventions were performed for duplex ultrasonography surveillance findings in 21 patients and for symptoms of persistent or recurrent critical limb ischemia in 9 patients. Procedural techniques included cutting balloon angioplasty (83%), conventional balloon angioplasty (7%), and stent placement (10%). Procedural success was achieved in all cases. There were no procedure-related complications, amputations, or deaths within 30 days. By Kaplan-Meier analysis, 37% of the patients were free from graft restenosis at 12 months and 31% were at 24 months. Receiver-operating characteristic analysis indicated that a lesion length of 1.75 cm best predicted freedom from restenosis (C statistic: 0.74). Residual stenosis (P = 0.03), patency without reintervention (P = 0.01), and assisted patency with secondary intervention (P = 0.02) rates were superior for short lesions compared with long lesions. The cohort had acceptable rates of adverse clinical outcomes, with 96% of patients free from amputation at both 12 and 24 months; clinical outcomes were also better in patients with short lesions.
  
  
  CONCLUSIONS
  In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, rates of limb preservation were high, but the majority of patients developed graft restenosis within 12 months. Grafts with longer stenoses fared poorly by comparison. These data suggest that endovascular interventions to restore or prolong graft patency may be associated with maintained graft patency and that close follow-up with vascular laboratory surveillance is essential.
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Medical Center, New York, NY. Electronic address: Greg.Westin@nyumc.org.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Westin
authors.affiliation: Division of Cardiology, University of Colorado Denver and VA Eastern Colorado Healthcare System, Denver, CO.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Usman
authors.initials: U
authors.lastname: Javed
authors.affiliation: Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, MO.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Balwanz
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Haseeb
authors.initials: H
authors.lastname: Saeed
authors.affiliation: Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: William C
authors.initials: WC
authors.lastname: Pevec
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: John R
authors.initials: JR
authors.lastname: Laird
authors.affiliation: Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: David L
authors.initials: DL
authors.lastname: Dawson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D057510:Endovascular Procedures; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011152:Popliteal Vein; D012042:Registries; D017211:Treatment Failure; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
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