Percutaneous Transluminal Angioplasty in the Treatment of Vein Graft Stenosis

Abstract

Vein graft stenosis is a precursor to graft failure and its management is controversial. The authors reviewed their experience with percutaneous transluminal angioplasty (PTA) for these lesions. Thirty-one infrainguinal vein grafts (30 patients) underwent 59 PTAs at 44 different sites. Mean patient age was 66.7 years, and 17 (57%) were men. Hemodynamically significant lesions (>50% diameter reduction) were established by duplex scan or angiography. All patients had follow-up duplex graft surveillance. Determination of recurrence was based on duplex criteria (peak systolic velocity >200 cm/sec, velocity ratio >2). PTA outcomes at 3 months were divided into successful and unsuccessful categories. Eight stenoses were excluded from this assessment secondary to follow-up < 3 months. All bypass grafts were patent through their last evaluation. Ninety percent of lesions (46/51) received adequate initial dilations. The successful group (41/51 lesions, 80%) had a mean follow-up of 10.8 months (range 3.0-26.3). In this group, 12 lesions recurred with a mean time from PTA of 5.3 months (range 3.0-13.6). Of the 10 unsuccessfully treated lesions, five were angioplasty failures and five recurred within 3 months. The distal anastomosis was the most unsuccessful location to be treated (P=0.01). The length of the lesions and the age of the graft did not influence outcome (P>0.05). There were two complications from PTA: an occlusion effectively treated with thrombolytic therapy and one distal embolization. In conclusion, 80% (41/51) of stenoses treated with PTA were successful for at least 3 months. Two thirds of first-time lesions were stenosis-free at 1 year. PTA is a safe, reasonable method for the management of vein graft stenosis. The distal anastomosis is the most difficult site to manage.