Patency of infrainguinal bypass grafts after endovascular treatment of distal anastomotic steno-obstructive lesions

Aim. Thrombosis is the most common complication of infrainguinal bypass graft procedures, the main factors being myointimal hyperplasia at the level of the distal anastomosis or the development of atherosclerosis. Owing to the complexity of redo surgery at this site, endovascular techniques are indicated for the repair of these lesions. Methods. From January 1999 to June 2001, a total of 19 patients received 20 combined interventions of infrainguinal bypass thrombectomy and endovascular treatment of distal anastomotic single obstructive lesions (1.5-2 cm in length). Percutaneous transluminal angioplasty (PTA) was performed in 11 alloplastic femoro-popliteal bypass grafts and in 9 saphenous vein below-knee bypass grafts (6 femoro-popliteal, 2 femoro-posterior tibial, 1 femoro-peroneal bypass graft). Stenting was performed in 8 cases of femoro-popliteal bypass (72.7%) and in 6 cases of below-knee bypass (66.6%). Results. The Kaplan-Meyer test showed that the early and 36-month patency rates were 100% and 61.1%, respectively, with a 95% limb salvage rate at 36 months (only 1 thigh amputation 6 months after combined thrombectomy and stenting of a femoro-peroneal bypass). In the above-knee and below-knee districts, 36-month patency rates were 55.5% and 66.6%, respectively (p<0.7 NS). Moreover, 2 cases (25%) of above-knee and 3 (50%) of below-knee bypass obstruction were observed after stenting of the distal anastomosis (p<0.7 NS). The time period between the primary and secondary operations ranged from 2 to 84 months (average, 13.8 months). Conclusion. Primary patency and limb salvage rates showed that, because of the technical difficulties in operating on an area with a high component of scar tissue, endovascular procedures for the treatment of small, single anastomotic stenoses associated with infrainguinal bypass thrombosis may be considered an effective alternative to conventional redo surgery.