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Perspectives in Vascular Surgery and Endovascular Therapy
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Treatment of Failing Lower Extremity Arterial Bypasses Under Ultrasound Guidance

Natalie Marks, MD, RVT

Maimonides Medical Center, Division of Vascular Surgery, Brooklyn, New York, nmarks{at}maimonidesmed.org

Enrico Ascher, MD

Maimonides Medical Center, Division of Vascular Surgery, Brooklyn, New York

Anil P. Hingorani, MD

Maimonides Medical Center, Division of Vascular Surgery, Brooklyn, New York

Endovascular repair of failing infrainguinal bypasses can effectively improve patency and limb salvage results in selected cases. We attempted to perform balloon angioplasties of 47 failing grafts in 3 patients under duplex guidance to eliminate or diminish the use of nephrotoxic contrast material and radiation exposure. The technical success was 98% (46/47 cases). One case of the outflow lesion in the plantar artery could not be traversed with the guidewire due to extreme tortuosity. Overall local complications rate was 4% (2 cases). One vein bypass pseudoaneurysm caused by rupture with cutting balloon was repaired by patch angioplasty and 1 SFA pseudoaneurysm at the puncture site required open repair. Overall 6- and 12-month primary patency rates were 70% and 50%, respectively.

Duplex guidance of failing infrainguinal arterial bypasses appears to be an effective treatment modality. Advantages include visualization of the puncture site, accurate selection of the proper size balloon, and confirmation of the adequacy of the technique by hemodynamic and imaging parameters. Additional benefits are avoidance of radiation exposure and contrast material in most cases.

Key Words: balloon angioplasty • failing arterial bypass • duplex-guided • renal insufficiency

Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 19, No. 1, 34-39 (2007)
DOI: 10.1177/1531003506298141
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