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Comparative Study
. 2016 Jan;63(1):142-7.
doi: 10.1016/j.jvs.2015.08.065. Epub 2015 Oct 17.

Open surgical revision provides a more durable repair than endovascular treatment for unfavorable vein graft lesions

John C McCallum  1 , Rodney P Bensley  1 , Jeremy D Darling  1 , Allen D Hamdan  1 , Mark C Wyers  1 , Chantel Hile  1 , Raul J Guzman  1 , Marc L Schermerhorn  2
Affiliations
Comparative Study

Open surgical revision provides a more durable repair than endovascular treatment for unfavorable vein graft lesions

John C McCallum et al. J Vasc Surg. 2016 Jan.

Abstract

Objective: Lower extremity bypass grafts that develop stenoses are commonly treated with either open surgical or endovascular revision. Vein graft stenoses with unfavorable lesions (multiple lesions, lesions >2 cm in length, lesions in grafts <3 months old, lesions in grafts <3 mm in diameter) fare worse than those with favorable lesions when treated with endovascular therapy. However, it is not known if unfavorable lesions fare better with surgical revision than with endovascular treatment or than favorable lesions treated with surgery.

Methods: We performed a retrospective review of 175 vein graft revisions performed at a single institution from 2000 to 2010. Characteristics of lesions treated with surgical and endovascular revision were identified. Cox proportional hazard models were used to identify predictors of revision failure (restenosis >75%, revision, or amputation).

Results: Ninety-one failing vein grafts (52%) were treated with surgical revision and 84 with endovascular treatment (48%), with a median follow-up of 30 months. Favorable lesions fared better than unfavorable lesions after endovascular treatment, with 12-month freedom from failure of 59% vs 34% (P < .01), but not after surgical revision (66% vs 62%; P = .90). Unfavorable lesions had better freedom from failure after surgery than endovascular treatment (62% vs 34%; P < .01), and results in favorable lesions were similar (66% vs 59%; P = .57).

Conclusions: For the treatment of failing vein grafts, endovascular therapy appears adequate for favorable lesions and surgical revision is more durable for unfavorable lesions.

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Figures

Figure 1
Figure 1
Freedom from revision failure after surgical revision and endovascular treatment of favorable and unfavorable vein graft lesions
See this image and copyright information in PMC

References

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