Balloon angioplasty for revision of failing lower extremity bypass grafts.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of balloon angioplasty as the primary method of intervention in patients with color duplex ultrasound documented failing bypass grafts and to determine factors that may affect the patency of lower extremity bypass grafts revised by percutaneous transluminal angioplasty (PTA).

METHODS: All consecutive patients who underwent lower extremity bypass grafts from January 2009 to December 2013 were enrolled in a graft surveillance program. Patients identified as having failing grafts underwent arteriography to confirm the diagnosis with a view to concomitant treatment of the lesion using balloon angioplasty. Procedural success was defined as <30% residual stenosis. Treatment failure was defined as target lesion restenosis or graft occlusion. Descriptive and life-table analyses were performed.

RESULTS: PTA was used to revise 96 failing grafts in 90 patients. Mean age was 65.8 years (range, 50-88 years), 64% were male, and 66% were symptomatic. Mean follow-up was 18.5 months (range, 3-24 months). Twenty-four grafts (25%) underwent repeat angioplasty for restenosis. Grafts with multiple lesions (P = .009) and grafts aged <6 months from the index operation (P = .004) were the only graft-related variables that showed a significant effect on the longevity of the endovascular revision. The PTA-revised grafts had primary, assisted primary, and secondary patency rates of 56.9%, 83.2%, and 90%, respectively, at 2 years.

CONCLUSIONS: Primary balloon angioplasty of failing lower extremity bypass grafts, notwithstanding the higher restenosis rate and the need for reintervention, appears to be safe and is associated with acceptable early and medium-term patency rates. Grafts with multiple lesions and those revised ≤6 months of the index operation showed a significant association with the need for a second revision at the same site.