CLINICAL-RESULTS OF COMMON STRATEGIES USED TO REVISE INFRAINGUINAL VEIN GRAFTS

Purpose: Patients who have failing infrainguinal bypass grafts or fade d grafts reopened with lytic therapy represent a group at high risk of subsequent failure. Previous studies suggest that vein patch angiopla sty and jump grafting may be less durable than interposition grafting as a method of correcting graft lesions. Our objective was to assess t he value of various technical strategies grafts and to assess how thes e variables might affect cumulative graft patency (CGP) rates. Methods : We retrospectively reviewed the clinical course, anatomic sites of r evision, and type of revision performed on 67 grafts in 58 patients wh o underwent at least one revision from 1991 to 1995. Results were asse ssed with regression analysis and Kaplan-Meier estimates of CGP rates (p <0.05 was considered significant). Results: Sixty-seven vein grafts underwent revision of 112 anatomical sites in 95 operations. Forty-ni ne of 67 grafts were single-segment greater saphenous vein grafts and 18 were composite (>1 segment) grafts, with an overall 5-year CGP rate of 72%. No difference was observed between the 4-year CGP rate in gra fts with hemodynamically significant distal anastomotic stenoses repai red primarily with jump grafts (n=20, 71% CGP rate) and those with ste noses found only in the graft body (n=41, 89% CGP rate). Vein patch an gioplasty was used primarily, but not exclusively, for focal graft bod y stenoses (n=35), whereas interposition grafts (n=11) were reserved f or more diffuse strictures; no significant difference in 3-year CGP ra tes was observed (94% and 73%, respectively). Conclusion: Using an app ropriate revision strategy that favors vein patch angioplasty for graf t body lesions and jump grafts for distal anastomotic lesions, accepta ble assisted patency rates can be achieved in grafts that are at risk for repeated failure.