J Korean Surg Soc.  2012 Nov;83(5):307-315. 10.4174/jkss.2012.83.5.307.

Treatment of failing vein grafts in patients who underwent lower extremity arterial bypass

• Park KM
• Park YJ
• Yang SS
• Kim DI
• Kim YW

• KMID: 2145008
• DOI: http://doi.org/10.4174/jkss.2012.83.5.307

Abstract

PURPOSE
We attempted to determine risk factors for the development of failing vein graft and optimal treatment in patients with infrainguinal vein grafts.
METHODS
We retrospectively reviewed a database of patients who underwent infrainguinal bypass using autogenous vein grafts due to chronic atherosclerotic arterial occlusive disease of lower extremity (LE) at a single institute between September 2003 and December 2011. After reviewing demographic, clinical, and angiographic features of the patients with failing grafts, we analyzed those variables to determine risk factors for the development of failing grafts. To determine an optimal treatment for the failing vein grafts, we compared results of open surgical repair (OSR), endovascular treatment (EVT) and conservative treatment.
RESULTS
Two hundred and fifty-eight LE arterial bypasses using autogenous vein grafts in 242 patients were included in this study. During the follow-up period of 39 +/- 25 months (range, 1 to 89 months), we found 166 (64%) patent grafts with no restenosis, 41 (15.9%) failing grafts, 39 (15.1%) graft occlusions, and 12 (4.7%) grafts lost in follow-up. In risk factor analysis for the development of a failing graft, no independent risk factors were identified. After 50 treatments of the 41 failing grafts (24 OSR, 18 EVT, 8 conservative management), graft occlusion was significantly more common in conservative treatment group and severe (>75%) restenosis was significantly more common following EVT than OSR (P = 0.001). Reintervention-free graft patency was also superior in the OSR group to that of the EVT group (87% vs. 42%, P = 0.015).
CONCLUSION
OSR of failing grafts has better outcomes than EVT or conservative management in treating failing grafts.

Keyword

Lower extremity; Bypass; Failing graft; Stenosis; Graft occlusion

MeSH Terms

Arterial Occlusive Diseases
Constriction, Pathologic
Follow-Up Studies
Humans
Lower Extremity
Retrospective Studies
Risk Factors
Transplants
Veins

Figure

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  Fig. 1 A failing vein graft near the proximal anastomosis of femoro-distal bypass. (A) Duplex ultrasonography showed high (730 cm/sec) peak systolic velocity at the stenotic lesion; (B) tight stenosis (arrow) on digital subtraction angiography; and (C) operative photo of stenotic segment of vein graft close to the proximal anastomosis.

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  Fig. 2 Treatment of a failing graft. (A) Failing graft (arrow) close to the proximal anastomosis; (B) after balloon angioplasty (arrow) of the stenotic lesion; (C) vein patch angioplasty; and (D) proximal graft extension with a new vein graft.

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  Fig. 3 Primary assisted (A) and reintervention-free patency rates (B) in surgical and endovascular treatment groups.

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