Management of bypass graft occlusion of lower extremity

Abstract

To explore the experience of management of graft occlusion in patients with lower extremity bypass grafting. From July 2002 to September 2009, 115 cases of graft occlusion were treated in 64 patients with lower extremity arterial bypass, including medical therapy for 8 cases and redo operations for 107 cases: graft thrombectomy alone for 32 cases, redo bypass operation with prosthetic grafts for 27 cases, graft thrombectomy plus balloon angioplasty for 17 cases, major amputation for 13 cases, graft thrombectomy plus endarterectomy for 10 cases, removal of occluded graft with infection for 4 case, distally bypass grafting with autologous saphenous vein for 3 case, and autologous stem cell transplanting for 1 case. One patient died of acute renal failure during peri-operative period and 3 patients died during follow-up period, 5 patients were lost to follow-up including 2 with medical therapy. The remaining 55 patients were followed up for 4 to 70 months (average 39 months): medical therapy for 8 patients, major amputation for 12 patients (21.8%), and patent grafts after reconstruction in 35 patients (63.6%). For graft occlusions after lower extremity bypass grafting, redo bypass operation and graft thrombectomy plus endarterectomy or balloon angioplasty may produce better early results.