The efficacy of endovascular treatment in acute symptomatic femoropopliteal bypass graft obstructions

Femoropopliteal bypass grafting is one of the treatment options for lower extremity arterial occlusive diseases. Several studies indicate an approximately 70% 5-year patency rate for autologous vein grafts and a 40% to 50% 5-year patency for PTFE grafts. Occlusion or stenosis of bypass grafts often results in limb-threating ischemia. There are four treatment options for femoropopliteal bypass graft occlusions or stenosis. These options are conservative management, surgical thrombectomy, graft replacement and endovascular treatment options. If none of these treatment approaches is successful, amputation can be performed. In recent years, because of the less invasiveness of endovascular treatment options, they have become the first choice management for occlusive or stenotic femoropopliteal bypass grafts. However some studies suggest that although the initial success rate of endovascular treatment options are high, the long term patency rates are not as good as surgical treatment options. For this reason, there is no consensus about the treatment approach of femoropopliteal bypass graft thrombosis or stenosis. From February, 1997 to March, 2012, 40 acute thrombosed or stenotic femoropopliteal bypass grafts in 35 patients that were treated with endovascular treatment options at the Department of Interventional Radiology in the University of Baskent Hospital, Ankara, were included to our study. Patient ages range from 31 to 86 years. Endovascular procedures, performed on thrombosed or hemodinamically significant stenotic grafts were catheter directed intraarterial thrombolytic therapy, percutaneous transluminal angioplasty and stent placement. After the endovascular procedures, patients were followed by cardiovascular surgeon. In the follow-up, the graft patency was determined by physical examination. Patients with suspected graft failure were evaluated by color or duplex Doppler ultrasound examination, computerized tomography angiography, magnetic resonance angiography (1,5T) or digital subtraction angiography. In recent years, because of the less invasiveness of endovascular treatment options, these options have taken over for femoropopliteal bypass greft obstructions which can result in severe ischemia. Although there were many studies about the treatment options for femoropopliteal bypass graft obstructions, the treatment approach is stil controversial. The goal of this study was to evaluate the effectiveness of endovascular treatment options for acute femoropopliteal bypass graft occlusions or stenosis by comparing post-procedural treatment success, patency rate, reocclusion or restenosis rate, amputation rate, complication rate with the other treatment options.