Lower-extremity in situ saphenous vein grafts: angiographic interventions

In 16 consecutive patients, thrombosis, anastomotic and intragraft stenoses, and residual venous communications (arteriovenous fistulas [AVFs]), after in situ saphenous vein bypass of femoropopliteal and infrapopliteal arteries, were treated with interventional angiographic techniques. Streptokinase infusion for graft thrombosis was performed in four patients, with long-term clinical improvement in two; in the other two, early rethrombosis was treated with surgical thrombectomy. Delayed rethrombosis occurred at 13 months in another patient. Anastomotic (six occasions) and intragraft (four occasions) stenoses in six patients were dilated with percutaneous transluminal angioplasty (PTA). Two grafts subsequently occluded, one 3 weeks and one 3 months after PTA. Residual AVFs were occluded in ten patients. Ten of 16 patients remained clinically improved without further therapy. One complication occurred: A graft stenosis developed at the site where a coil, protruding from the AVF into the graft lumen, was successfully removed and replaced.