Assisted patency with primary stent placement in distal anastomotic stenoses of lower limb bypass grafts

To evaluate the feasibility and effectiveness of primary stent placement for treating distal anastomotic infragenicular bypass stenoses in terms of technical success and middle-term (2-year) patency rates.

Twenty-one patients underwent primary stent placement for the treatment of distal anastomotic stenoses after infragenicular bypasses. Patients underwent clinical and color flow and duplex Doppler ultrasonographic (US) examinations 1, 3, 6, and 12 months after the endovascular procedure and every year thereafter if no complications occurred. Angiography was performed in patients with positive findings at the clinical and US examinations to evaluate the need for repeat endovascular and/or surgical treatment. The mean follow-up was 18.3 months (range, 2-30 months).

Twenty-two clinically significant (>50%) distal anastomotic stenoses were detected in 22 infragenicular grafts created in the 21 patients. The median time between endovascular treatment and surgery was 7.5 months (range, 3-18 months). The mean stenosis length was 1.4 cm (range, 0.8-2.4 cm). Twenty-four stents were implanted, two of which were used to treat restenosis immediately below the previously implanted stent. The technical success rate was 100%. No complications occurred during any of the treatments, and no periprocedural major events or complications were registered. At follow-up, the cumulative primary, primary assisted, and secondary patency rates for the treated graft stenoses were 95%, 95%, and 100%, respectively, at 6 months; 71%, 81%, and 86% at 1 year; and 71%, 76%, and 81% at 2 years. The limb salvage rate was 88%.

Although this study was limited to a small number of patients, stent placement seems to be a feasible and effective tool in the endovascular treatment of distal anastomotic infragenicular bypass graft stenoses.