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Durability of vein graft revision: the outcome of secondary procedures. J Vasc Surg 1991 Feb;13(2):200-8; discussion 209-10

Date

02/01/1991

Pubmed ID

1990161

DOI

10.1067/mva.1991.26224

Scopus ID

2-s2.0-0025730989   93 Citations

Abstract

Occlusive lesions that reduced graft blood flow and ankle systolic pressure were identified in 83 femorodistal saphenous vein bypasses by use of duplex scanning or arteriography. Sites of stenosis included vein conduit (n = 41), anastomoses (n = 20), outflow arteries (n = 15), or inflow (n = 9) arteries. One hundred three secondary procedures consisting of vein-patch angioplasty (n = 31), sequential (n = 21) or interposition (n = 17) graft placement, percutaneous transluminal balloon angioplasty (n = 17), or excision of the lesion and primary anastomosis (n = 16) were performed to correct primary (n = 85) or recurrent (n = 18) graft stenoses. Cumulative graft patency after reintervention was 96% at 1 year, and 85% at 5 years. Stenosis or occlusion of revision sites was less after excision (0 of 16) or replacement (1 of 17) of abnormal segments compared to vein-patch angioplasty (8 of 31) or balloon angioplasty (9 of 18). Sequential or jump grafts constructed to improve graft outflow impaired by either myointimal or atherosclerotic occlusive lesions were the least durable secondary procedures. Five of eight graft failures in this series resulted from sequential/jump graft occlusion. All categories of secondary procedures normalized graft and limb hemodynamics, although only one third of patients reported symptoms of limb ischemia before revision. Surveillance of infrainguinal vein bypasses for occlusive lesions is a valid concept to salvage patent but hemodynamically-failing grafts. Secondary procedures that excised the lesion, used autologous tissue reconstruction, and normalized hemodynamics at the revision site and in the vein bypass were associated with a low incidence of restenosis and prolonged graft patency.

Author List

Bandyk DF, Bergamini TM, Towne JB, Schmitt DD, Seabrook GR

Author

Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Arterial Occlusive Diseases
Female
Graft Occlusion, Vascular
Hemodynamics
Humans
Leg
Male
Middle Aged
Reoperation
Saphenous Vein
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc