Femoropopliteal Venous Bypass Studied with Intravascular Ultrasound: A Case Report

Abstract

To describe the ability of intravascular ultrasound (IVUS) to document the status of the greater saphenous vein during bypass surgery, the long-term changes in the bypass, and the effects of balloon angioplasty on vein graft stenoses. An 80-year-old female underwent in situ femoropopliteal venous bypass grafting. Vein graft stenosis developed 6 months later, necessitating balloon angioplasty. The angioplasty failed, and a polytetrafluoroethylene (e-PTFE) interposition graft was placed. Ten months after bypass surgery, balloon angioplasty was performed for new stenoses. This procedure also failed, and the venous bypass and interposition graft were removed and replaced by an e-PTFE graft. IVUS images obtained during the first surgery were compared with those obtained 10 months later. Histologic sections were used to confirm the IVUS findings. IVUS detected a distinct narrowed venous segment, pre-existent intimal thickening, and disrupted valves. Over the follow-up period, both the pre-existent intimal thickening and the narrowed segment evolved into stenoses, necessitating treatment. Luminal gain after balloon angioplasty of graft stenosis was associated with vascular damage. This report shows that IVUS has the ability to document long-term venous bypass alterations and to demonstrate the effect of balloon angioplasty on venous bypass stenoses.