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 s tenoses were detected after a mean follow-up of 7.2 months by Duplex-u ltrasound. The initial success rate after PTA was 100%. After an avera ge time of 4.6 months recurrent graft stenoses were identified in 8 by passes 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 assi sted 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 ag e > 30 days) with clinical symptoms of incomplete ischaemia was analyz ed retrospectively. After successful lysis in 61% (22/36), 15 grafts u nderwent additional procedures including PTA (10), vein patch angiopla sty (4) and distal graft extension (1). Following successful initial g raft salvage, primary cumulative patency and limb salvage rates were 4 5 and 72% at 1 month and 16 and 51% at 3 years. PTA of primary graft s tenoses may be regarded as an acceptable initial therapeutic option, b ut has some limitations in providing sustained patency. Grafts initial ly salvaged with lysis do not have favourable short and long-term pate ncy.