THE ROLE OF INTERVENTIONAL PROCEDURES IN THE TREATMENT OF STENOSED AND OCCLUDED INFRAINGUINAL ARTERIAL BYPASS GRAFTS

In a prospective study, the results following PTA of 30 short stenoses > 70% in 17 infrainguinal arterial bypass grafts were examined. The stenoses were detected after a mean follow-up of 7.2 months by Duplex-ultrasound. The initial success rate after PTA was 100%. After an average time of 4.6 months recurrent graft stenoses were identified in 8 bypasses and 1 patient experienced graft thrombosis. Overall 8 of the 17 patients with stenotic grafts were treated by PTA alone during a mean follow-up of 11.7 months. Using life-table analysis, primary and assisted primary patency rates were each 100% at 1 month and 41 and 86% at 2 years. The efficacy of thrombolysis in 36 occluded grafts (graft age > 30 days) with clinical symptoms of incomplete ischaemia was analyzed retrospectively. After successful lysis in 61% (22/36), 15 grafts underwent additional procedures including PTA (10), vein patch angioplasty (4) and distal graft extension (1). Following successful initial graft salvage, primary cumulative patency and limb salvage rates were 45 and 72% at 1 month and 16 and 51% at 3 years. PTA of primary graft stenoses may be regarded as an acceptable initial therapeutic option, but has some limitations in providing sustained patency. Grafts initially salvaged with lysis do not have favourable short and long-term patency.