Endovascular treatment of distal anastomotic stenoses in infrainguinal bypasses

Aim. The ­late com­pli­ca­tion ­that ­most fre­quent­ly ­leads to the fail­ure of infra­in­gui­nal ­bypass sur­gery con­sists of throm­bo­sis ­caused by myoin­ti­mal hyper­pla­sia phe­nom­e­na at the lev­el of the dis­tal anas­tom­o­sis or fol­low­ing the evo­lu­tion of ath­e­ros­cle­rot­ic dis­ease. Endovascular sur­gery is indi­cat­ed for the cor­rec­tion of ­these ­lesions ­owing to the com­plex­ity of ­redo sur­gery at ­this lev­el. Methods. A com­par­a­tive ret­ro­spec­tive ­study was ­made of 20 ­patients under­go­ing dis­tal anas­tom­o­sis PTA ­after throm­bec­to­my of the infra­in­gui­nal ­bypass dur­ing the peri­od January 1989/March 1999. In 12 cas­es sur­gery was per­formed at the lev­el of the suprag­e­nic­u­lar seg­ment (11 ­with allo­plas­tic bypass­es, 1 ­with ­vein ­graft ­bypass) and 8 at the lev­el of the infra­ge­nic­u­lar seg­ment (1 ­with allo­plas­tic ­bypass and 7 ­using the saph­e­nous ­vein). A ­stent was ­used in 5 cas­es of allo­plas­tic ­bypass. ­Results. Statistical anal­y­ses ­using the Kaplan-Meyer ­test ­showed ­total imme­di­ate paten­cy in 75%, and 48.7% at 36 ­months, ­with ­limb sal­vage in 95% and 83.3%, respec­tive­ly. In par­tic­u­lar, in the suprag­e­nic­u­lar dis­trict, pri­mary paten­cy and at 36 ­months was 75% and 37.5% ver­sus 75% and 62.5% in the infra­ge­nic­u­lar dis­trict. Conclusions. The ­results of the endo­vas­cu­lar pro­ce­dures per­formed as ­redo sur­gery may be ­less effi­ca­cious in ­terms of paten­cy com­pared to pri­mary pro­ce­dures. However, in ­view of the tech­ni­cal dif­fi­cul­ties cor­re­lat­ed ­with ­redo sur­gery, ­these ­results ­should be con­sid­ered sat­is­fac­to­ry, ­above all in ­terms of ­limb sal­vage.