IS PERCUTANEOUS BALLOON ANGIOPLASTY APPROPRIATE IN THE TREATMENT OF GRAFT AND ANASTOMOTIC LESIONS RESPONSIBLE FOR FAILING VEIN BYPASSES

We reviewed 95 cases of vein graft and anastomotic lesions treated wit h percutaneous transluminal balloon angioplasty (PTA) and 30 cases tre ated surgically. The therapy was deemed a failure if tile lesion recur red or if the graft closed. The 21-month patency rate of lesions treat ed surgically was 86%, which was significantly better than tile 42% pa tency rate for all lesions treated with PTA (P <0.01). An evaluation o f the lesion and graft characteristics that could influence the patenc y of stenotic legions treated with PTA included: lesion length, minimu m graft diameter, lesion location, and lesion type. The 66% patency ra te at 24 months for the 41 simple lesions (single, nonrecurrent, <15 m m in length, and within grafts greater than or equal to 3 mm minimal d iamater) was significantly better than the 17% patency rate for the 50 complex lesions (multiple, recurrent, greater than or equal to 15 mm in length, or within grafts <3 mm in minimal diameter) (P <0.01). In a ddition, the 21-month patency rate for the surgically treated group (8 6%) was not significantly better than that of the angioplasty-treated simple lesions (86%). When feasible, vein graft lesions are best treat ed with simple surgical interventions. PTA can be useful to maintain t he patency of severely compromised grafts prior to surgical repair, to treat simple lesions difficult to reach surgically, and for patients with medical contraindications for an operation.