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Management of failing prosthetic bypass grafts with metallic stent placement

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Abstract

Purpose: To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts.

Methods: Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n=3), rest pain (n=9), and minor or major tissue loss (n=3). Lesions were at the proximal anastomosis (n=6), the distal anastomosis (n=3), or within the graft (n=6).

Results: Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement (at a mean of 10.8 months). Three late deaths occurred during follow-up.

Conclusion: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.

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Authors and Affiliations

  1. Institute for Vascular Health and Disease, Albany Medical College, A-113, 47 New Scotland Avenue, 12208, Albany, NY, USA

    Gary P. Siskin, Brian F. Stainken, Valerie S. Mandell, R. Clement Darling, Kyran Dowling & Allen Herr

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  1. Gary P. Siskin
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  2. Brian F. Stainken
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  3. Valerie S. Mandell
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  4. R. Clement Darling
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  6. Allen Herr
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Siskin, G.P., Stainken, B.F., Mandell, V.S. et al. Management of failing prosthetic bypass grafts with metallic stent placement. Cardiovasc Intervent Radiol 22, 375–380 (1999). https://doi.org/10.1007/s002709900410

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