[Interventions in infrainguinal bypass grafts].

Area of Science:

• Vascular Surgery
• Interventional Radiology

Background:

• Long-term infrainguinal bypass graft success necessitates precise surgical technique and consistent postoperative surveillance.
• Graft patency is threatened by stenotic lesions, requiring effective detection and management strategies.

Purpose of the Study:

• To review current methods for maintaining infrainguinal bypass graft patency.
• To evaluate the role of duplex scanning, percutaneous transluminal angioplasty (PTA), and fibrinolytic therapy in managing graft stenosis and occlusion.

Main Methods:

• Review of literature on infrainguinal bypass graft surveillance and intervention.
• Discussion of duplex scanning for stenotic lesion detection.
• Analysis of percutaneous transluminal angioplasty (PTA) and intra-arterial fibrinolytic therapy as alternatives to surgery.

Main Results:

• Duplex scanning is the preferred method for detecting stenotic lesions affecting graft patency.
• PTA demonstrates high technical success rates (up to 100%) and a 5-year primary assisted patency of up to 65% for specific lesion types.
• Fibrinolytic therapy achieves high technical success rates (up to 92%) for bypass graft occlusion, offering reduced trauma and improved run-off vessel lysis.

Conclusions:

• Meticulous surgical technique and regular surveillance are crucial for infrainguinal bypass graft longevity.
• Duplex scanning is essential for early detection of graft-threatening stenosis.
• PTA and fibrinolytic therapy represent valuable, less invasive treatment options for specific infrainguinal bypass complications.