ANGIOPLASTY OF DISTAL VENOUS BYPASSES - IS IT WORTH THE COST

Saphenous vein is the best graft for long term patency infragenicular bypass. During follow-up, stenoses can appear on the graft. Is angiopl asty a good solution for the treatment of these lesions? During the fo llow-up of 612 saphenous bypass with below-knee distal anastomosis, 90 stenoses (over 70%) were discovered, Among them 36 were treated with transluminal angioplasty (34 bypasses). Stenoses were detected at a me an follow-up of 7 months after bypass realization. They were located 1 7 times on the graft itself and 19 times near the anastomoses and they were never longer than 5 cm. Percutaneous approach was prefered for 1 1 cases and surgical for the others, Immediate success was obtained in 33 cases (91%). Among the 3 failed cases 2 needed a new bypass. Mean follow-up was 33 months after the initial bypass and 24 months after a ngioplasty, Graft patency was ensured by a single angioplasty in 18 ca ses, Assisted primary patency, cumulative patency, Limb salvage rate w ere respectively 65%, 91%, 100% at one year and 53%, 72%, 96% at 2 yea rs. Transluminal angioplasty can be advised for the treatment of short stenosis of infrainguinal vein graft: this technique has a weak risk, little surgical aggressiveness, short hospitalisation. Results are ac ceptable and not very different with the location of the stenosis.