Outcome of endovascular reintervention for significant stenosis at infrainguinal bypass anastomoses

The durability of an infrainguinal bypass may be hampered by development of stenosis at the anastomoses. We describe the patency of percutaneous transluminal angioplasty (PTA) of these anastomotic stenoses.

Any venous or prosthetic infrainguinal bypass with a hemodynamically significant anastomotic stenosis, symptomatic or asymptomatic, was considered a bypass at risk (BAR) for occlusion. All BARs undergoing PTA in two large vascular referral centers between January 2005 and December 2010 were retrospectively reviewed. Procedural success was defined as <30% residual stenosis. Primary end points were primary, assisted primary, and secondary patency rates.

Included were 43 patients with 43 BARs (31 venous, 11 prosthetic, and 1 unknown conduit; 19 supragenicular and 24 infragenicular). Mean follow-up was 17 months (range, 0-57 months). Procedures constituted 48 interventions for proximal (n = 13), distal (n = 25), or combined (n = 5) anastomotic stenoses. Procedural success was 96%. The primary, assisted primary, and secondary patency rates were 58%, 85%, and 88%, respectively, at 2 years.

PTA for infrainguinal BAR due to anastomotic stenosis is technically feasible with acceptable durability. PTA for these anastomotic stenoses may be considered a safe option as the first-line treatment.