Late Secondary Infrainguinal Bypass for Reocclusion after Laser Angioplasty: A Ten-Year Follow-up

Abstract

To evaluate the late long-term results of secondary vascular procedures after failed laser angioplasty, 64 infrainguinal bypasses performed for reocclusions occurring after laser angioplasty of the superficial femoral artery were reviewed. In 56 of 64 (88%) limbs, the superficial femoral artery lesion undergoing initial laser angioplasty was an occlusion greater than 20 cm in length. Concurrent popliteal stenotic lesions were present in 24 of the 64 (38%) limbs, which were simultaneously angioplastied with a balloon catheter but without laser. Thirty-two (50%) limbs had a less-than-2-vessel tibial-peroneal runoff. The mean interval between the initial laser angioplasty and the secondary bypass operation was 14.5 months. Secondary infrainguinal reconstructions included 38 abovethe-knee, 20 below-the-knee, and 6 femorotibial-peroneal bypasses. At the secondary procedures, no early graft failures or deaths occurred within 30 postoperative days. Oneyear primary patency and limb-salvage rates for the secondary bypass were 60% and 66%, respectively. Laser angioplasty did not preclude the possibility but did limit durability of secondary bypass operations.