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Percutaneous angioplasty for infrainguinal graft-related stenoses
A D Houghton1, C Todd, B Pardy
1Department of Surgery, Guys Hospital, London, U.K.
Objective:
To assess the success of percutaneous transluminal angioplasty (PTA) in treating infrainguinal graft-related stenoses.
Design:
Retrospective analysis of stenoses undergoing PTA over 6 years.
Materials:
Fifty-seven stenoses in 42 grafts.
Methods:
Site, length and type of stenoses recorded. Follow-up till discharge, graft occlusion or death.
Results:
PTA was successful in 48/57 stenoses in 36 grafts (G), with a poor result in seven. Further PTA was required in seven stenoses (7 G). One graft occluded at PTA and one stenosis was inaccessible. Overall graft (G) patency (median 13 months) was 82% (1 year patency 84%). Of 48 successful PTAs (37 G), 36 remained patent (28 G), eight (4 G) occluded and four were lost to follow-up (4 G). Fourteen of thirty-six stenoses which remained patent required further intervention (seven PTA, six jump grafts, one vein patch). The four occlusions were associated with small veins (two), multiple stenoses (one) and a PTFE graft which occluded 10 days following PTA. Of the seven PTAs with a poor angiographic result, five remained patent, three after further intervention.
Conclusion:
PTA is the best treatment for localised stenoses. Stenoses > 2 cm or multiple (three or more) stenoses are best treated surgically. Follow-up is essential, as 20% require further intervention.