Long-term Outcomes of Endovascular Therapy for Failing Vein Grafts after Distal Bypass Surgery

Abstract

Objective: Although distal bypass surgery using vein grafts has been established with acceptable outcomes for critical limb ischemia, the issue affecting long-term outcomes is vein graft disease. This study aimed to analyze the perioperative and long-term outcomes of endovascular therapy (EVT) for failing vein grafts after distal bypass surgery. Methods: We retrospectively analyzed 50 failing vein grafts out of 315 vein grafts used for distal bypass from April 2009 to October 2016 in our hospital. The failing grafts were repaired by balloon angioplasty with a balloon size of 2.5 to 3.0 mm under low pressure and long inflation. Results: The initial success rate of 96% (48 grafts). During the median follow-up periods of 42 months, the frequency of EVT was 1.9 times. Secondary patency rate of the grafts were 83% at 12 months and 76% at 36 months. Freedom from major amputation rate was 95% at 36 months. Conclusion: Long-term outcomes including patency rate and amputation free rate of EVT for failing veins grafts were acceptable in this study. EVT could be a viable alternative to surgical revascularization in patients with graft failure after distal bypass surgery.