Long-term follow-up of management of failing in situ saphenous vein bypassgrafts using endovascular intervention techniques

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.