Duplex features of vein graft stenosis and the success of percutaneous transluminal angioplasty

Purpose: To determine if criteria exist that are correlated to a successful outcome after balloon angioplasty for vein graft stenosis. Methods: During a 5-year period, duplex surveillance of 380 infrainguinal v ein bypasses identified 76 hemodynamically failing grafts (87 stenoses) req uiring intervention. Percutaneous transluminal angioplasty (PTA) was select ed over surgical repair based on 3 criteria: time interval from primary gra fting procedure, vein graft diameter, and stenosis length. The 28 (32%) ste noses (20 grafts) treated by PTA were used in a retrospective analysis to t est if any variables favored a successful outcome. Patient and lesion chara cteristics, graft patency, and restenosis following PTA were correlated wit h duplex features of the stenosis recorded prior to, immediately after, and at 3- to g-month intervals postprocedurally. Results: Lesion characteristics that correlated with a successful outcome w ere vein size greater than or equal to 3.5 mm, lesion length < 2 cm, and ap pearance > 3 months after surgery. Conduit type, PTA site, patient demograp hics, and indication for bypass did not correlate with PTA durability. Nine teen lesions in 13 grafts met these criteria (group 1), while 9 stenoses in 7 grafts did not (group 2). Lesion severity based on duplex velocity measu rements were similar in both groups before (p = 0.40) and after(p = 0.32) t reatment. During the mean 21-month follow-up, group 1 grafts required less intervention (p = 0.035). At last follow-up, hemodynamic changes were durab le in group 1 (p = 0.0068) but not in group 2 (p = 0.39). Conclusions: Selection of vein graft stenoses for treatment by PTA can be b ased on temporal and duplex data. PTA of short (< 2 cm) stenoses in good ca liber veins (greater than or equal to 3.5 mm) appearing > 3 months after by pass placement was durable with a late intervention rate of approximately 1 0%. Direct surgical repair or replacement is recommended for early (< 3 mon ths) and/or long segment stenoses that develop in small caliber conduits.