Rh. Goh et al., Long-term follow-up of management of failing in situ saphenous vein bypassgrafts using endovascular intervention techniques, J VAS INT R, 11(6), 2000, pp. 705-712
PURPOSE: To report the long-term follow-up of previously reported cases of
salvaging failing or failed in situ bypass grafts using endovascular techni
ques, to include previously unreported cases, and to include the results of
thrombolysis for the salvage of occluded in situ venous bypass grafts.
MATERIALS AND METHODS: Between 1985 and 1995, 352 patients underwent distal
bypass via the in situ saphenous vein. Seventy-three of these patients und
erwent endovascular interventions for (i) graft stenoses (65 lesions in 40
patients) treated by balloon angioplasty (PTA), (ii) AV residual fistulas t
o veins (AVF) (23 patients) occluded by coil embolotherapy, (iii) graft occ
lusion (21 occluded grafts in 19 patients) treated by catheter-directed hig
h-dose thrombolytic infusion and PTA or surgical revision of uncovered sten
oses, and (iv) retained valve leaflets causing stenoses (five patients) tre
ated by valvectomy and/or PTA. Cumulative patency sates were determined by
the Kaplan-Meier method, Twenty-nine of 73 patients had been previously rep
orted by the authors,
RESULTS: PTA was successful in 39 of 40 patients, cumulative patency after
bypass PTA was 0.79 (SE +/- 0.07) for 12 months and 0.63 (SE +/- 0.12) for
5 years. The only complication of PTA was a graft anastomotic disruption th
at was successfully treated by surgery. Longer lesions and lesions requirin
g repeated PTA were more likely to restenose, For thrombolysis, there were
13 of 19 successful infusions and five delayed occlusions, The cumulative p
atency for both 12 months and 5 years was 0.43 (SE +/- 0.12), AVF embolizat
ion was successful in 21 of 23 patients. Cumulative patency for 12 months a
nd 5 years was 0.87 (SE +/- 0.07) and 0.81 (SE +/- 0.09), respectively, Fiv
e successful valvectomy procedures were performed by stripping residual val
ves with endocardial forceps.
CONCLUSION: In experienced hands, PTA and AVF embolization can be performed
on failing in situ saphenous vein bypass grafts with good long-term patenc
y, Thrombolysis results were less favorable but can prolong patency of graf
ts.