Secondary interventions in patients with autologous infrainguinal bypass grafts strongly improve patency rates
Hidde Jongsma1, Joost A Bekken1, Fons van Buchem1
1Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
Insights
Secondary interventions are common after percutaneous transluminal angioplasty (PTA) for at-risk infrainguinal bypasses. However, repeated interventions maintain over 80% bypass patency at one year.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Infrainguinal bypasses are crucial for limb salvage.
- Bypass grafts are susceptible to stenosis and occlusion.
- Percutaneous transluminal angioplasty (PTA) is a treatment option for at-risk bypasses.
Purpose of the Study:
- To evaluate the patency rates of autologous infrainguinal bypasses treated with PTA.
- To determine the frequency of secondary interventions required after PTA.
- To assess the long-term outcomes of PTA in preserving bypass function.
Main Methods:
- Retrospective single-center cohort study.
- Included 69 patients undergoing primary PTA of infrainguinal autologous bypasses (2009-2013).
- Duplex ultrasound surveillance for at least 1 year post-PTA; primary endpoint: secondary interventions.
Main Results:
- Technical success rate of 91% for PTA.
- 1-year primary assisted patency: 84%; secondary patency: 86%.
- 43% of bypasses remained free of stenosis/occlusion; 14% occluded; 42% developed recurrent stenosis.
Conclusions:
- Secondary interventions are frequently needed after PTA for at-risk bypasses.
- Repeated interventions can achieve favorable 1-year patency rates (>80%) for infrainguinal bypasses.
- PTA is an effective strategy for maintaining bypass patency, though repeat procedures are common.
Objective:
To describe the patency of percutaneous transluminal angioplasty (PTA) of autologous infrainguinal bypasses at risk.
Methods:
This was a retrospective single-center cohort study of consecutive patients who underwent primary PTA of an infrainguinal autologous bypass at risk from January 2009 to December 2013. Duplex ultrasound surveillance was performed for at least 1 year after PTA. The primary study end point was the number of secondary interventions. Secondary end points were freedom from recurrent stenosis or bypass occlusion and the patency of the infrainguinal autologous bypass at 1 year after primary PTA.
Results:
A total of 69 infrainguinal bypasses at risk in 69 patients were identified and treated with PTA. Technical success was achieved in 91%. The median follow-up was 17 months (range, 1-58 months). During follow-up, 30 bypasses (43%) remained free of significant stenosis or bypass occlusion, 29 bypasses (42%) developed recurrent stenosis, and 10 bypasses (14%) occluded. Rates of primary assisted, and secondary patency at 1 year were 84%, and 86%. Five (7%) major amputations were performed, all after bypass occlusion.
Conclusions:
Secondary interventions after PTA of a bypass at risk are common. However, repeated secondary interventions of autologous infrainguinal bypasses at risk result in patency rates of more than 80% at 1 year.
More Related Videos
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Aneurysm III: Interprofessional Care
01:22Aneurysm IV: Nursing Management