Outcome of Surgical and Endoluminal Intervention for Infrainguinal Bypass Anastomotic Strictures

• Published in: Vascular and endovascular surgery 2006-01, Vol.40 (1), p.11-22
• Main Authors: Eagleton, Matthew J., Erez, Orry, Srivastava, Sunita D., Henke, Peter K., Upchurch, Gilbert R., Stanley, James C., Wakefield, Thomas W.
• Format: Article
• Language: English
• Subjects: Aged; Anastomosis, Surgical - statistics & numerical data; Angiography; Angioplasty, Balloon - statistics & numerical data; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Cardiovascular system; Diseases of the cardiovascular system; Follow-Up Studies; Graft Occlusion, Vascular - prevention & control; Graft Occlusion, Vascular - surgery; Graft Occlusion, Vascular - therapy; Hospitals, University; Humans; Inguinal Canal - blood supply; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Michigan; Middle Aged; Postoperative Complications - surgery; Postoperative Complications - therapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reoperation - statistics & numerical data; Secondary Prevention; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/153857440604000102

The objective of this study was to compare the outcomes of percutaneous transluminal angioplasty (PTA) versus open surgical repair of anastomotic strictures affecting infrainguinal bypasses. Anastomotic strictures affecting 39 bypasses in 36 patients were identified among 593 consecutive infrainguinal arterial reconstructions performed between 1994 and 2004. The mean age of affected patients was 65 ±2 years (range: 61 to 101 years). The original bypasses, with vein grafts outnumbering prosthetic grafts 2 to 1, were performed for acute (5%) and chronic (54%) limb-threatening ischemia, disabling claudication (28%), or popliteal aneurysms (13%). Anastomotic strictures were first recognized an average of 16 ±3 months (range 2 to 92 months) postoperatively. Strictures affected the distal anastomosis in 62% of cases and the proximal anastomosis in 38%. Primary patency, assisted primary patency, secondary patency, and limb salvage were assessed following PTA or open surgical repair of the strictures. Anastomotic strictures were detected following acute (41%) and chronic (18%) limbthreatening ischemia, claudication (13%), or during routine graft surveillance (28%) in asymptomatic patients. Graft thrombosis, occurring in 51% of patients at the time of presentation, was not affected by the site of anastomotic stricture, although prosthetic grafts were affected more than vein grafts (92% vs 31%). Interventions included PTA (67%) and conventional open procedures (33%). The latter included vein patch angioplasty, short interposition grafts, and redo bypasses. The stricture site and bypass material used in the original revascularization did not affect reintervention patency rates. Sixteen (62%) of the endovascular procedures were performed on a graft presenting with thrombosis, while only 4 (31%) were initially treated with operative therapy. Treatment of thrombosed grafts resulted in an 18-month patency of 32% compared to an 80% patency in treating grafts that were not occluded at the time of presentation (p