Radiological intervention for the failing in situ vein bypass

With close surveillance, deteriorating hemodynamics may signal a failing in situ bypass that can be salvaged by timely intervention. The purpose of this report is to summarize our experience with in situ bypass salvage using interventional radiology. Twenty-nine patients underwent arteriography following bypass occlusion or when an ankle/brachial index reduction of greater than 0.15 was detected between two consecutive office visits. Eighteen percutaneous transluminal dilatations were performed; one patient underwent repeat dilatation after 36 months, a second had four dilatations over 40 months. Ten significant arteriovenous fistulae were identified and were successfully embolized with 3 mm coils. One patient underwent excision of a retained valve. Six patients had initial fibrinolytic therapy for graft occlusion. The morbidity of these interventions was low; one bypass was disrupted following percutaneous transluminal dilatation but was successfully salvaged surgically. The average time from the original surgery to intervention was six months (one to 26 months); and the average follow-up after intervention was 22 months (three to 62 months) over which time patency was maintained in the majority. When a correctable problem is identified with appropriate vascular lab surveillance, interventional radiology is a useful alternative to surgery for bypass salvage.