Endovascular Therapy is Effective Treatment for Focal Stenoses in Failing Infrapopliteal Vein Grafts

Autor: Haseeb Saeed, Usman Javed, Christopher R. Balwanz, Ehrin J. Armstrong, David L. Dawson, Gregory G. Westin, John R. Laird, William C. Pevec
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Male
Duplex ultrasonography
medicine.medical_treatment
6.3 Medical devices
Cardiovascular
Graft Occlusion
Restenosis
80 and over
Registries
Treatment Failure
Ultrasonography
Aged
80 and over
Peripheral Vascular Diseases
Assistive Technology
Ultrasonography
Doppler
Duplex
Endovascular Procedures
Doppler
Angiography
Graft Occlusion
Vascular
General Medicine
Middle Aged
Limb Salvage
Duplex
Treatment Outcome
Female
Radiology
medicine.symptom
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Popliteal Vein
Clinical Sciences
Bioengineering
Article
Vascular
Angioplasty
medicine
Vascular Patency
Humans
Aged
business.industry
Evaluation of treatments and therapeutic interventions
Critical limb ischemia
Vascular surgery
Atherosclerosis
medicine.disease
Surgery
Cardiovascular System & Hematology
Amputation
Cutting balloon
business
Zdroj: Annals of vascular surgery, vol 28, iss 8
Popis: Background To evaluate the efficacy of endovascular therapy for maintaining patency and preserving limbs among patients with failing infrapopliteal bypass grafts. Methods We gathered data from a registry of catheter-based procedures for peripheral artery disease. Of 1554 arteriograms performed from 2006 to 2012, 30 patients had interventions for failing bypass vein grafts to infrapopliteal target vessels. The first intervention for each patient was used in this analysis. Duplex ultrasonography was used within 30 days after intervention and subsequently at 3- to 6-month intervals for graft surveillance. Results Interventions were performed for duplex ultrasonography surveillance findings in 21 patients and for symptoms of persistent or recurrent critical limb ischemia in 9 patients. Procedural techniques included cutting balloon angioplasty (83%), conventional balloon angioplasty (7%), and stent placement (10%). Procedural success was achieved in all cases. There were no procedure-related complications, amputations, or deaths within 30 days. By Kaplan–Meier analysis, 37% of the patients were free from graft restenosis at 12 months and 31% were at 24 months. Receiver-operating characteristic analysis indicated that a lesion length of 1.75 cm best predicted freedom from restenosis (C statistic: 0.74). Residual stenosis ( P = 0.03), patency without reintervention ( P = 0.01), and assisted patency with secondary intervention ( P = 0.02) rates were superior for short lesions compared with long lesions. The cohort had acceptable rates of adverse clinical outcomes, with 96% of patients free from amputation at both 12 and 24 months; clinical outcomes were also better in patients with short lesions. Conclusions In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, rates of limb preservation were high, but the majority of patients developed graft restenosis within 12 months. Grafts with longer stenoses fared poorly by comparison. These data suggest that endovascular interventions to restore or prolong graft patency may be associated with maintained graft patency and that close follow-up with vascular laboratory surveillance is essential.
Databáze: OpenAIRE
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