Management of Acute Infrainguinal Graft Occlusion: Surgical and Endovascular Approaches in Contemporary Practice

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Therapy

Background:

• Acute infrainguinal bypass graft occlusion presents a significant vascular emergency, jeopardizing limb viability.
• Current revascularization strategies offer suboptimal outcomes, lacking a consensus on the best treatment approach.
• Understanding the epidemiology, etiology, diagnosis, and treatment is crucial for managing this condition.

Purpose of the Study:

• To review current evidence on acute infrainguinal bypass graft occlusion.
• To highlight the roles of catheter-directed thrombolysis, mechanical thrombectomy, and prevention strategies.
• To discuss the evolving landscape of surgical versus endovascular management.

Main Methods:

• Narrative review of existing literature.
• Analysis of factors influencing bypass graft failure (technical, anatomical, systemic).
• Evaluation of vein versus prosthetic graft occlusion mechanisms.

Main Results:

• Infrainguinal bypass failure involves diverse mechanisms for vein and prosthetic grafts.
• Endovascular techniques show promise for minimally invasive treatment with favorable short-term results.
• Surgical thrombectomy remains an option for select cases.
• Duplex surveillance and medical optimization are key for preventing occlusion and reducing amputation risk.

Conclusions:

• Timely diagnosis and a multidisciplinary approach are essential for managing acute graft occlusion.
• Endovascular therapies broaden treatment options, but long-term outcome data are limited.
• Further prospective studies are required to establish optimal strategies for this high-risk patient group.