Early results of percutaneous transluminal angioplasty (PTA) of failing below-knee bypass grafts.

Objectives: An audit of treating femoro-crural bypass stenosis in the first instance by PTA.

Design: Prospective clinical pilot study in consecutive patients.

Materials: Prior to vascular bypass grafting all patients had critical ischaemia. Sixty-four PTA procedures in 50 grafts in 49 patients were carried out. Thirteen were in situ saphenous grafts, 16 were combined venous segments, 18 were combined PTFE and vein and three were PTFE only.

Methods: Conventional cross-over or antegrade PTA, eventually combined with local thrombolytic therapy.

Results: The nine-month assisted patency using PTA was 72%, following surgical repair in five cases after failed PTA the secondary patency was 86%. The amputation free survival rate was 88%. In 11 cases thrombosis was treated successfully with local thrombolysis. In two cases the balloon ruptured the native artery wall below the distal anastomosis with pseudoaneurysm formation. Six limbs were amputated during follow-up. The frequency of stenosis in combined grafts was significantly higher than in in situ vein grafts.

Conclusion: Our results are comparable with surgery. About 600 hospital beds/days were saved. This shortened the time from the diagnosis of stenosis to therapy and shortened the waiting list for vascular surgery.