A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts

L. A. Sanchez, S. K. Gupta, F. J. Veith, J. Goldsmith, R. T. Lyon, K. R. Wengerter, T. F. Panetta, M. L. Marin, Jacob Cynamon, G. Berdejo, Seymour Sprayregen, C. W. Bakal

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Between Jan. 1, 1980, and Dec. 31, 1989, 2187 infrainguinal revascularization procedures were performed. In 130 of these cases with patent bypasses, hemodynamic deterioration was suspected, and urgent arteriography was performed. Twenty additional patients with aortofemoral, femorofemoral, or axillofemoral bypasses demonstrated hemodynamic deterioration. In 93% of failing grafts the condition was suspected because of recurrent symptoms or changes in the pulse examination. Two hundred eighty-five high-grade stenotic or occlusive lesions were identified in inflow arteries, outflow arteries, within the graft, or at proximal or distal anastomoses associated with these 150 grafts. One hundred sixty-one (57%) of these lesions were in patients with failing vein grafts; 115 (40%) were in patients with failing polytetrafluoroethylene (PTFE) grafts; and 9 (3%) were associated with failing composite vein/PTFE grafts. Stenotic lesions <5 cm in length were initially treated with percutaneous transluminal balloon angioplasty (PTA). Occlusive lesions, stenoses >5 cm in length, and PTA failures were treated surgically. The overall 6-year cumulative secondary patency rate for failing grafts was 65%, and the limb salvage rate was 75%. The extended patency rate after the first intervention in the failing state was 56% at 5 years. The 5-year secondary patency rate for grafts initially treated with PTA (58%) was not significantly different (p = 0.25) from that for grafts treated initially with surgery (71%). Percutaneous transluminal angioplasty was effective for inflow stenoses of the iliac, femoral, and popliteal arteries and for some outflow lesions. The 24-month extended patency rate for lesions <1.5 cm in length within vein grafts ≥3 mm in diameter treated by percutaneous transluminal angioplasty (93%) was significantly better than that of lesions that were multiple, ≥1.5 cm in length, or within grafts <3 mm in diameter (54%) (p = 0.001). Frequent, careful surveillance can identify the failing state in both vein and PTFE arterial reconstructions. Percutaneous transluminal angioplasty is effective in treating most short (<5 cm) inflow or outflow lesions and graft stenoses <1.5 cm. Surgical interventions are necessary to treat recurrent, long, diffuse, or occlusive lesions. Early detection of failing grafts and timely intervention are essential for the long-term maintenance of arterial bypass grafts.

Original languageEnglish (US)
Pages (from-to)729-738
Number of pages10
JournalJournal of Vascular Surgery
Volume14
Issue number6
DOIs
StatePublished - 1991

Fingerprint

Polytetrafluoroethylene
Veins
Transplants
Angioplasty
Pathologic Constriction
Arteries
Hemodynamics
Popliteal Artery
Limb Salvage
Iliac Artery
Femoral Artery
Pulse
Angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Sanchez, L. A., Gupta, S. K., Veith, F. J., Goldsmith, J., Lyon, R. T., Wengerter, K. R., ... Bakal, C. W. (1991). A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts. Journal of Vascular Surgery, 14(6), 729-738. https://doi.org/10.1067/mva.1991.33159

A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts. / Sanchez, L. A.; Gupta, S. K.; Veith, F. J.; Goldsmith, J.; Lyon, R. T.; Wengerter, K. R.; Panetta, T. F.; Marin, M. L.; Cynamon, Jacob; Berdejo, G.; Sprayregen, Seymour; Bakal, C. W.

In: Journal of Vascular Surgery, Vol. 14, No. 6, 1991, p. 729-738.

Research output: Contribution to journalArticle

Sanchez, LA, Gupta, SK, Veith, FJ, Goldsmith, J, Lyon, RT, Wengerter, KR, Panetta, TF, Marin, ML, Cynamon, J, Berdejo, G, Sprayregen, S & Bakal, CW 1991, 'A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts', Journal of Vascular Surgery, vol. 14, no. 6, pp. 729-738. https://doi.org/10.1067/mva.1991.33159
Sanchez, L. A. ; Gupta, S. K. ; Veith, F. J. ; Goldsmith, J. ; Lyon, R. T. ; Wengerter, K. R. ; Panetta, T. F. ; Marin, M. L. ; Cynamon, Jacob ; Berdejo, G. ; Sprayregen, Seymour ; Bakal, C. W. / A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts. In: Journal of Vascular Surgery. 1991 ; Vol. 14, No. 6. pp. 729-738.
@article{17727b4a04ac4b13bfe90f92394126aa,
title = "A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts",
abstract = "Between Jan. 1, 1980, and Dec. 31, 1989, 2187 infrainguinal revascularization procedures were performed. In 130 of these cases with patent bypasses, hemodynamic deterioration was suspected, and urgent arteriography was performed. Twenty additional patients with aortofemoral, femorofemoral, or axillofemoral bypasses demonstrated hemodynamic deterioration. In 93{\%} of failing grafts the condition was suspected because of recurrent symptoms or changes in the pulse examination. Two hundred eighty-five high-grade stenotic or occlusive lesions were identified in inflow arteries, outflow arteries, within the graft, or at proximal or distal anastomoses associated with these 150 grafts. One hundred sixty-one (57{\%}) of these lesions were in patients with failing vein grafts; 115 (40{\%}) were in patients with failing polytetrafluoroethylene (PTFE) grafts; and 9 (3{\%}) were associated with failing composite vein/PTFE grafts. Stenotic lesions <5 cm in length were initially treated with percutaneous transluminal balloon angioplasty (PTA). Occlusive lesions, stenoses >5 cm in length, and PTA failures were treated surgically. The overall 6-year cumulative secondary patency rate for failing grafts was 65{\%}, and the limb salvage rate was 75{\%}. The extended patency rate after the first intervention in the failing state was 56{\%} at 5 years. The 5-year secondary patency rate for grafts initially treated with PTA (58{\%}) was not significantly different (p = 0.25) from that for grafts treated initially with surgery (71{\%}). Percutaneous transluminal angioplasty was effective for inflow stenoses of the iliac, femoral, and popliteal arteries and for some outflow lesions. The 24-month extended patency rate for lesions <1.5 cm in length within vein grafts ≥3 mm in diameter treated by percutaneous transluminal angioplasty (93{\%}) was significantly better than that of lesions that were multiple, ≥1.5 cm in length, or within grafts <3 mm in diameter (54{\%}) (p = 0.001). Frequent, careful surveillance can identify the failing state in both vein and PTFE arterial reconstructions. Percutaneous transluminal angioplasty is effective in treating most short (<5 cm) inflow or outflow lesions and graft stenoses <1.5 cm. Surgical interventions are necessary to treat recurrent, long, diffuse, or occlusive lesions. Early detection of failing grafts and timely intervention are essential for the long-term maintenance of arterial bypass grafts.",
author = "Sanchez, {L. A.} and Gupta, {S. K.} and Veith, {F. J.} and J. Goldsmith and Lyon, {R. T.} and Wengerter, {K. R.} and Panetta, {T. F.} and Marin, {M. L.} and Jacob Cynamon and G. Berdejo and Seymour Sprayregen and Bakal, {C. W.}",
year = "1991",
doi = "10.1067/mva.1991.33159",
language = "English (US)",
volume = "14",
pages = "729--738",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts

AU - Sanchez, L. A.

AU - Gupta, S. K.

AU - Veith, F. J.

AU - Goldsmith, J.

AU - Lyon, R. T.

AU - Wengerter, K. R.

AU - Panetta, T. F.

AU - Marin, M. L.

AU - Cynamon, Jacob

AU - Berdejo, G.

AU - Sprayregen, Seymour

AU - Bakal, C. W.

PY - 1991

Y1 - 1991

N2 - Between Jan. 1, 1980, and Dec. 31, 1989, 2187 infrainguinal revascularization procedures were performed. In 130 of these cases with patent bypasses, hemodynamic deterioration was suspected, and urgent arteriography was performed. Twenty additional patients with aortofemoral, femorofemoral, or axillofemoral bypasses demonstrated hemodynamic deterioration. In 93% of failing grafts the condition was suspected because of recurrent symptoms or changes in the pulse examination. Two hundred eighty-five high-grade stenotic or occlusive lesions were identified in inflow arteries, outflow arteries, within the graft, or at proximal or distal anastomoses associated with these 150 grafts. One hundred sixty-one (57%) of these lesions were in patients with failing vein grafts; 115 (40%) were in patients with failing polytetrafluoroethylene (PTFE) grafts; and 9 (3%) were associated with failing composite vein/PTFE grafts. Stenotic lesions <5 cm in length were initially treated with percutaneous transluminal balloon angioplasty (PTA). Occlusive lesions, stenoses >5 cm in length, and PTA failures were treated surgically. The overall 6-year cumulative secondary patency rate for failing grafts was 65%, and the limb salvage rate was 75%. The extended patency rate after the first intervention in the failing state was 56% at 5 years. The 5-year secondary patency rate for grafts initially treated with PTA (58%) was not significantly different (p = 0.25) from that for grafts treated initially with surgery (71%). Percutaneous transluminal angioplasty was effective for inflow stenoses of the iliac, femoral, and popliteal arteries and for some outflow lesions. The 24-month extended patency rate for lesions <1.5 cm in length within vein grafts ≥3 mm in diameter treated by percutaneous transluminal angioplasty (93%) was significantly better than that of lesions that were multiple, ≥1.5 cm in length, or within grafts <3 mm in diameter (54%) (p = 0.001). Frequent, careful surveillance can identify the failing state in both vein and PTFE arterial reconstructions. Percutaneous transluminal angioplasty is effective in treating most short (<5 cm) inflow or outflow lesions and graft stenoses <1.5 cm. Surgical interventions are necessary to treat recurrent, long, diffuse, or occlusive lesions. Early detection of failing grafts and timely intervention are essential for the long-term maintenance of arterial bypass grafts.

AB - Between Jan. 1, 1980, and Dec. 31, 1989, 2187 infrainguinal revascularization procedures were performed. In 130 of these cases with patent bypasses, hemodynamic deterioration was suspected, and urgent arteriography was performed. Twenty additional patients with aortofemoral, femorofemoral, or axillofemoral bypasses demonstrated hemodynamic deterioration. In 93% of failing grafts the condition was suspected because of recurrent symptoms or changes in the pulse examination. Two hundred eighty-five high-grade stenotic or occlusive lesions were identified in inflow arteries, outflow arteries, within the graft, or at proximal or distal anastomoses associated with these 150 grafts. One hundred sixty-one (57%) of these lesions were in patients with failing vein grafts; 115 (40%) were in patients with failing polytetrafluoroethylene (PTFE) grafts; and 9 (3%) were associated with failing composite vein/PTFE grafts. Stenotic lesions <5 cm in length were initially treated with percutaneous transluminal balloon angioplasty (PTA). Occlusive lesions, stenoses >5 cm in length, and PTA failures were treated surgically. The overall 6-year cumulative secondary patency rate for failing grafts was 65%, and the limb salvage rate was 75%. The extended patency rate after the first intervention in the failing state was 56% at 5 years. The 5-year secondary patency rate for grafts initially treated with PTA (58%) was not significantly different (p = 0.25) from that for grafts treated initially with surgery (71%). Percutaneous transluminal angioplasty was effective for inflow stenoses of the iliac, femoral, and popliteal arteries and for some outflow lesions. The 24-month extended patency rate for lesions <1.5 cm in length within vein grafts ≥3 mm in diameter treated by percutaneous transluminal angioplasty (93%) was significantly better than that of lesions that were multiple, ≥1.5 cm in length, or within grafts <3 mm in diameter (54%) (p = 0.001). Frequent, careful surveillance can identify the failing state in both vein and PTFE arterial reconstructions. Percutaneous transluminal angioplasty is effective in treating most short (<5 cm) inflow or outflow lesions and graft stenoses <1.5 cm. Surgical interventions are necessary to treat recurrent, long, diffuse, or occlusive lesions. Early detection of failing grafts and timely intervention are essential for the long-term maintenance of arterial bypass grafts.

UR - http://www.scopus.com/inward/record.url?scp=0026328619&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026328619&partnerID=8YFLogxK

U2 - 10.1067/mva.1991.33159

DO - 10.1067/mva.1991.33159

M3 - Article

VL - 14

SP - 729

EP - 738

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -