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Distal percutaneous transluminal angioplasty through infrainguinal bypass grafts
A-M Löfberg1, S Karacagil, C Ljungman
1Department of Radiology, University Hospital, Uppsala, Sweden.
Insights
Percutaneous transluminal angioplasty (PTA) for infrainguinal bypass grafts showed a 91% technical success rate. While long-term patency was limited, PTA is a viable alternative to surgery in select cases without jeopardizing future interventions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Endovascular Therapy
Background:
- Infrainguinal bypass grafts are crucial for limb salvage in peripheral artery disease.
- Stenotic or occlusive lesions at the distal anastomosis or in runoff arteries can compromise graft function.
- Percutaneous transluminal angioplasty (PTA) is an endovascular technique used to treat such lesions.
Purpose of the Study:
- To evaluate the outcomes of PTA in treating infrainguinal bypass graft lesions.
- To assess technical success, graft patency, and limb salvage rates following PTA.
- To compare PTA results with surgical revisions reported in the literature.
Main Methods:
- Retrospective clinical study of 41 patients undergoing 57 PTA procedures.
- Procedures targeted distal anastomoses, runoff arteries, or both.
- Lesions included stenoses and occlusions, primarily in popliteal and crural arteries.
Main Results:
- Technical success rate of 91% was achieved.
- Three-year primary and primary-assisted graft patency rates were 32% and 53%, respectively.
- No significant differences in patency were observed based on graft material, lesion type, or PTA level; no amputations resulted directly from failed PTA.
Conclusions:
- PTA outcomes for infrainguinal bypass graft lesions appear inferior to surgical revisions.
- PTA is a reasonable alternative to surgical intervention in selected patients.
- Failed PTA did not preclude subsequent vein-patch angioplasty or jump grafting, preserving limb salvage options.
Aim:
to evaluate the results of transluminal angioplasty (PTA) performed through infrainguinal bypass grafts for stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries.
Design:
retrospective clinical study.
Material And Methods:
forty-one patients underwent 57 procedures at the distal anastomosis (n=13), in the runoff arteries (n=32) or at both locations (n=12) at a median of 9.6 months (range, 2-76 months) after infrainguinal bypass grafting. Nineteen procedures were on the popliteal artery, the rest on the crural arteries. Eleven procedures related to occlusions less than 5 cm in length.
Results:
technical success was achieved in 91%. Primary and primary assisted graft patency rates at 3 years were 32% and 53%, respectively. There were no significant differences in patency rates with regard to the graft material, the type of lesion, the level of PTA, the status of runoff and the use of thrombolysis before PTA. No patients underwent amputation as a direct consequence of failed PTA or graft occlusion. One patient underwent acute surgical intervention due to graft occlusion at the time of attempted PTA.
Conclusion:
the results of PTA at the distal anastomosis and/or in the runoff arteries in limbs with infrainguinal bypass seemed to be inferior to the results of surgical revisions reported in literature. However, as failed PTA did not jeopardise vein-patch angioplasty or jump grafting, it is a reasonable alternative to surgical intervention in selected cases.