Predictors of failure after angioplasty of infrainguinal vein bypass grafts

• Published in: Journal of vascular surgery 2009, Vol.49 (1), p.117-121
• Main Authors: Simosa, Hector F., MD, Pomposelli, Frank B., MD, Dahlberg, Suzanne, PhD, Scali, Salvatore T., MD, Hamdan, Allen D., MD, Schermerhorn, Marc L., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Angioplasty, Balloon; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Constriction, Pathologic; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - surgery; Graft Occlusion, Vascular - therapy; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Patient Selection; Peripheral Vascular Diseases - surgery; Recurrence; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Saphenous Vein - transplantation; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Failure; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.08.010

Objective Percutaneous transluminal angioplasty (PTA) has had an expanding role as primary therapy for vein graft stenosis with variable results. The aim of this study is to identify patient and graft characteristics predictive of failure after PTA of infrainguinal vein grafts. Methods Retrospective review from Jan 2004 to Mar 2007 of patients undergoing angioplasty for failing grafts. Demographics, comorbidities, procedural data, and follow-up information were recorded. PTA failure was defined as first significant event including restenosis by duplex scan (>3.5 × velocity ratio), occlusion, redo-PTA, surgical revision, or amputation. Descriptive, logistic regression and life-table analyses were performed. Results Eighty-seven grafts in 79 patients underwent PTA. Mean age was 70 years (median 70; range, 39-89 years), 71% were male and 52% were symptomatic (40% with limb-threat). Mean follow-up was 17 months (median 17.4; range, 0.03-39.8 months). Freedom from PTA failure was 58% (standard error [SE] 0.0574) at 12 months. Predictors of PTA failure by multivariate analysis were: time from bypass 2 cm (HR 2.7; 95% CI 1.33-5.83; P = .007) and multiple stenoses (HR 2.5; 95% CI 1.29-5.1; P = .007). PTA patency for grafts with favorable lesions (single, less than 2 cm lesions in grafts older than 3 months) was 71% vs 35% for unfavorable lesions at 12 months. Limb-salvage was 95% and 90% and overall survival was 92% and 81% at 12 and 24 months, respectively. Conclusion PTA of failing infrainguinal vein grafts is a reasonable primary therapy for favorable lesions. Early graft stenosis, long, and multiple stenoses are markers for procedural failure and are better served with surgical revision.