Management of failing prosthetic bypass grafts with metallic stent placement

Purpose: To evaluate the role of metallic stents in treating stenoses invol ving prosthetic arterial bypass grafts. Methods: Patients undergoing stent placement within a failing prosthetic by pass graft, during a 41-month period, were reviewed for treatment outcome a nd complications. The indications for stent placement in 15 patients includ ed severe claudication (n = 3), rest pain (n = 9), and minor or major tissu e loss (n = 3). Lesions were at the proximal anastomosis (n = 6), the dista l anastomosis (n = 3), or within the graft (n = 6) Results. Treatment with metallic stents was successful in all patients. The re was one acute stent thrombosis, successfully treated with thrombolytic t herapy. Follow-up data are available for a mean duration of 12.3 months. Th e mean duration of primary patency was 9.4 months with 6- and 12-month prim ary patency rates of 51.9% and 37.0%, respectively. The mean duration of se condary patency was 12.1 months with 6- and 12-month secondary patency rate s of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients wer e revised surgically after stent placement (at a mean of 10.8 months). Thre e late deaths occurred during follow-up. Conclusion: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent placement repres ents a viable, short-term treatment option for stenoses within or at the an astomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.