Infrainguinal Vein Graft Stenoses: Long-Term Outcomes of Graft Angioplasty.
Graft angioplasty combines the durability and ability of surgical bypasses to treat long arterial occlusions with the minimally invasive nature of endovascular procedures. The purpose of this study was to evaluate the efficacy of single and repeated graft angioplasty in revising failing infrainguinal vein bypass grafts and to determine predictors of medium- and long-term freedom from revision after graft angioplasty.



This was a retrospective analysis from a prospectively maintained database. Consecutive endovascular revisions of graft-threatening lesions identified by duplex ultrasound surveillance were reviewed from 2003 to 2010. Patients were followed up until death, major amputation, or the end of follow-up, with the data last updated on January 1, 2013.



178 graft angioplasty procedures performed in 114 bypass grafts in 103 limbs from 98 patients were studied. At 5 years, freedom from revision was 22.6%, graft survival was 45.8%, amputation-free survival was 57.9%, and patient survival was 64.9%. Analysis of repeated angioplasties found no evidence that effectiveness diminishes significantly with the number of previous angioplasties performed (p=.892). Higher Rutherford Grade of ischemia and longer time interval from index surgery to first angioplasty were significant positive predictors of medium- and long-term patency.



Percutaneous transluminal angioplasty of infrainguinal vein grafts is safe and effective in the treatment of failing grafts identified by duplex surveillance. Graft angioplasties do not lose effectiveness when repeated and have shown cumulative benefit in prolonging graft survival. Treatment of claudicants and time interval from graft implantation of more than 6 months at the time of first angioplasty are positive predictors of at least medium-term patency after graft angioplasty.
Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK.
K
K
Mathur
Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK. Electronic address: rajiv@vohra.org.uk.
R K
RK
Vohra
Department of Statistics, Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK.
J
J
Hodson
Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK.
S
S
Kuyumdzhiev
Department of Interventional Vascular Radiology, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK.
M J
MJ
Duddy
Department of Interventional Vascular Radiology, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK.
J D
JD
Hopkins
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods; D014680:Veins / Q000601:surgery*
Freedom from revision; Graft survival; Infrainguinal; Vein graft angioplasty