Behaviour of surgically corrected infrainguinal vein grafts

During a period of 4 years (1988-1992) we detected in a series of 114 infrainguinal vein grafts 22 bypasses (19%) with 26 hemodynamically significant (> 50%) stenoses. The secondary cumulative patency rate of 114 bypasses was 92% at 12, 84% at 24 and 84% at 36 months. Twenty-three secondary surgical procedures consisting of vein patch angioplasty (n = 10), interposition grafting (n = 3) or jump- or sequential grafting (n = 10) were performed to correct stenoses. One graft correction was technically not feasible, resulting in graft occlusion. Two patients refused surgery. All corrected grafts were prospectively studied both by ankle brachial measurements and color flow Duplex scanning every 3 to 6 months. Cumulative graft patency after reintervention in 20 grafts was 95% at 12 months and 95% at 24 months. Mild stenosis (< 50%) of revision sites was observed in 2 grafts. No single stenosis remote of revision site developed during follow-up (mean 20.4 months), confirming the opinion that stenosed vein grafts after correction do not demonstrate a higher incidence to develop strictures than normal grafts. No tertiary procedures were necessary, as all categories of secondary procedures normalized graft and limb hemodynamics. This series demonstrates that excellent long term results after surgically corrected high grade graft lesions justify an aggressive approach to these stenoses.