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Management of failing prosthetic bypass grafts with metallic stent placement
G P Siskin1, B F Stainken, V S Mandell
1Institute for Vascular Health and Disease, Albany Medical College, A-113, 47 New Scotland Avenue, Albany, NY 12208, USA.
Insights
Metallic stents offer a viable short-term treatment for prosthetic arterial bypass graft stenoses. While primary patency rates were moderate, secondary patency remained high, providing a valuable option for patients with limited life expectancy.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomaterials Engineering
Background:
- Prosthetic arterial bypass grafts are susceptible to stenoses, leading to graft failure and limb-threatening ischemia.
- Surgical revision of failing grafts carries significant morbidity and mortality risks.
- Metallic stents have emerged as a potential endovascular solution for managing graft stenoses.
Purpose of the Study:
- To evaluate the efficacy and safety of metallic stent placement in treating stenoses within prosthetic arterial bypass grafts.
- To assess outcomes including patency rates and complications associated with metallic stent use.
- To compare metallic stenting as a treatment option against traditional surgical revision.
Main Methods:
- A retrospective review of 15 patients who underwent metallic stent placement for failing prosthetic bypass grafts over 41 months.
- Analysis of indications for stenting, including severe claudication, rest pain, and tissue loss.
- Evaluation of lesion location (proximal anastomosis, distal anastomosis, or within the graft) and treatment outcomes.
Main Results:
- Successful stent placement in all patients with one acute stent thrombosis successfully treated.
- Mean primary patency of 9.4 months, with 6- and 12-month rates of 51.9% and 37.0%, respectively.
- Mean secondary patency of 12.1 months, with 6- and 12-month rates of 80.0% and 72.7%, respectively. Amputations occurred in two patients; six required surgical revision.
Conclusions:
- Metallic stent placement is a viable short-term treatment for prosthetic graft stenoses, especially in patients with limited life expectancy.
- The procedure offers a less invasive alternative to surgical revision, with acceptable secondary patency rates.
- Further research is needed to directly compare intragraft stenting with surgical graft revision for optimal patient management.
Purpose:
To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts.
Methods:
Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n = 3), rest pain (n = 9), and minor or major tissue loss (n = 3). Lesions were at the proximal anastomosis (n = 6), the distal anastomosis (n = 3), or within the graft (n = 6).
Results:
Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement (at a mean of 10.8 months). Three 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 represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.