Infrainguinal Bypass Grafts Research Articles

Does Gender Influence the Patency of Infrainguinal Bypass Grafts?

Infrainguinal revascularization is an effective method of treatment for femoropopliteal/tibial occlusive diseases. However, these bypass grafts are prone to stenosis. In this retrospective study, the authors investigate the association of gender with patency of infrainguinal bypass grafts. The outcomes for consecutive 375 male and 200 female patients who underwent infrainguinal bypass surgery for arterial occlusive disease are compared, and associations with characteristics of the patients, surgical procedure, and graft stenosis are determined. It is found that several demographic, biochemical, and etiological factors could influence the patency of bypass procedures in different genders. However, infrainguinal arterial reconstruction procedures performed in women have a worse outcome when compared with that in men.

Ultra-sound guided sciatic nerve block combined with lumbar plexus block for infra-inguinal artery bypass graft surgery

Ultra-sound guided sciatic nerve block combined with lumbar plexus block for infra-inguinal artery bypass graft surgery

Statins are independently associated with reduced mortality in patients undergoing infrainguinal bypass graft surgery for critical limb ischemia

Evidence suggesting a beneficial effect of cardioprotective medications in patients with lower extremity atherosclerosis derives largely from secondary prevention studies of heterogeneous populations. Patients with critical limb ischemia (CLI) have a large atherosclerotic burden with related high mortality. The effect of such therapies in this population is largely inferred and unproven. The Project of Ex-Vivo vein graft Engineering via Transfection III (PREVENT III) cohort comprised 1404 patients with CLI who underwent lower extremity bypass grafting in a multicenter, randomized prospective trial testing the efficacy of edifoligide for the prevention of graft failure. Propensity scores were used to evaluate the influence of statins, beta-blockers, and antiplatelet agents on outcomes while adjusting for demographics, comorbidities, medications, and surgical variables that may influence drug use. Primary outcomes were major adverse cardiovascular events < or =30 days, vein graft patency, and 1-year survival assessed by Kaplan-Meier method. Potential determinants of 1-year survival were modeled using a multivariate Cox regression. In this cohort, 636 patients (45%) were taking statins, 835 (59%) were taking beta-blockers, and 1121 (80%) were taking antiplatelet drugs. Perioperative major adverse cardiovascular events (7.8%) and early mortality (2.7%) were not measurably affected by the use of any drug class. Statin use was associated with a significant survival advantage at 1 year of 86% vs 81% (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52-0.98; P = .03) by analysis of both unweighted and propensity score-weighted data. Use of beta-blockers and antiplatelet drugs had no appreciable impact on survival. None of the drug classes were associated with graft patency measures at 1 year. Significant predictors of 1-year mortality by Cox regression modeling were statin use (HR, 0.67; 95% CI, 0.51-0.90; P = .001), age >75 (HR, 2.1; 95% CI, 1.60-2.82; P = .001), coronary artery disease (HR, 1.5; 95% CI, 1.15-2.01; P = .001), chronic kidney disease stages 4 (HR, 2.0; 95% CI, 1.17-3.55; P = .001) and 5 (HR, 3.4; 95% CI, 2.39-4.73; P < .001), and tissue loss (HR, 1.9; 95% CI, 1.23-2.80; P = .003). Statin use is associated with improved survival in CLI patients 1 year after surgical revascularization. Further studies are indicated to determine optimal dosing in this population and to definitively address the question of relationship to graft patency. These data add to the growing literature supporting statin use in patients with advanced peripheral arterial disease.

Duplex Guided Balloon Angioplasty of Failing Infrainguinal Bypass Grafts

Duplex Guided Balloon Angioplasty of Failing Infrainguinal Bypass Grafts

Recanalization of an Occluded Infrainguinal Vein Graft Complicated by Graft Aneurysm

The technique of subintimal angioplasty has been described for the recanalisation of native vessels after occlusion of infrainguinal vascular bypass grafts. We report a case in which an attempt at such treatment resulted in inadvertent but successful recanalisation of the occluded vein graft instead. This was complicated by graft perforation and subsequent graft aneurysm which was successfully treated with a covered stent.

Is Infrainguinal Bypass Grafting Successful Following Failed Angioplasty?

Is Infrainguinal Bypass Grafting Successful Following Failed Angioplasty?

A personal experience with the influence of diabetes and other factors on the outcome of infrainguinal bypass grafts for occlusive disease

To investigate the influence of diabetes mellitus and other factors on the outcome of all infrainguinal bypass grafts performed for occlusive disease by a single surgeon at a tertiary referral center. The series includes 650 operations in 412 men and 238 women with median ages of 65 and 69 years, respectively. Critical ischemia was the indication for most procedures (n = 553, 85%), but 97 (15%) were done for claudication alone. Nearly half (n = 312, 48%) of the patients were diabetic, and 195 (30%) required insulin. All-autogenous vein was used for 389 grafts (60%). Synthetic or composite materials were employed for the remaining 261 grafts, 91 (35%) of which were entirely above the knee. Perioperative data were recorded contemporaneously and were supplemented by reviewing 558 of the 565 medical records and the Social Security Death Index. Survival, graft patency, and limb salvage were analyzed using logistic regression, Kaplan-Meier estimates and proportional hazards models. Diabetics were more likely to have critical preoperative limb ischemia (P < .001), elevated serum creatinine (P = .003) or a history of previous coronary intervention (P = .015), lower extremity revascularization (P < .001) or minor amputations (P = .002). The operative mortality rate was 4.8%, and there were 81 graft occlusions (12%) and 49 major amputations (7.5%) during the index hospital admission. Patency was immediately restored in 46 of the 81 occluded grafts, but their secondary patency rates were only 62 +/- 16% at 1 year and 26 +/- 18% at 5 years. Insulin-dependent diabetes was associated with a higher incidence of early amputation (odds ratio, 2.6; 95% confidence interval [CI], 1.4-4.8; P = .004). Overall survival was 52 +/- 4% at 5 years and 25 +/- 5% at 10 years, and there were 175 late graft occlusions (27%), a total of 198 related reoperations and 107 late amputations (16%). The risks for further occlusion and/or major amputation after three or more graft revisions were 65% and 71%, respectively. Insulin-dependent diabetes also was associated with higher late mortality (hazard ratio [HR], 1.5; 95% CI, 1.2-1.8; P = .001) and amputation rates (HR, 1.5; 95% CI, 1.0-2.1; P = .026), but other independent variables like age, elevated serum creatinine, critical preoperative ischemia, synthetic conduits, and previous ipsilateral bypass had at least as much influence as diabetes on survival, graft failure or limb loss. Diabetes was one of several factors influencing survival and limb preservation, but it did not adversely affect graft patency. The number of graft revisions was an important predictor of further occlusion or amputation.

Is Infrainguinal Bypass Grafting Successful Following Failed Angioplasty?

Angioplasty is often used in the management of lower limb ischaemia and can reduce the need for infrainguinal bypass in some patients. There is an associated failure rate with this technique and bypass surgery is often used in this situation as a secondary limb salvage procedure. We aimed to evaluate the outcome of infrainguinal bypass grafting following failed attempt at angioplasty. All cases of infrainguinal bypass at a single centre over a seven year period were identified and notes reviewed. Cases were divided into four groups according to their indication for surgery; acute ischaemia, chronic critical ischaemia, failed angioplasty and an 'other' group including aneurysmal disease and claudicants. The failed angioplasty group was compared with the other three groups. Survival analysis was performed using Kaplan Meier curves and groups compared in terms of long term patency and survival. Primary patency was 61.2% in the failed angioplasty group at 12 months compared with 60.6% in the other groups (P=1.11). There was also no significant difference in primary patency at 60 months (50% vs 40.6%, P=0.26). Survival at 12 months was also comparable between the groups (failed angioplasty group 74.2% compared with 77.3% in the other groups, P=0.662) as was 60 months survival (33.3% and 35.4% respectively, P=0.166). In this study, outcome of infrainguinal bypass following failed angioplasty was comparable to outcome of surgery performed for another indication. This paper supports the use of distal bypass surgery for limb salvage in cases where minimal access techniques have failed.

Superficial femoral artery percutaneous intervention is an effective strategy to optimize inflow for distal origin bypass grafts

Iliac angioplasty in preparation for an infrainguinal bypass graft has been shown to be an effective strategy. We undertook this study to determine if superficial femoral artery (SFA) angioplasty offers durable inflow for distal origin grafts originating from the SFA or popliteal artery. All distal origin grafts performed at a single institution between 1988 and 2006, </=30 days of an ipsilateral SFA percutaneous intervention, were reviewed retrospectively. Patients were identified from a computerized vascular registry, and data were obtained by review of patient charts, angiograms, and duplex studies. We identified 23 autogenous distal origin grafts procedures performed distal to an SFA intervention, of which 22 were performed for critical limb ischemia (96%). The SFA lesions intervened on (20 angioplasty alone, 3 angioplasty with stenting) included 11 TransAtlantic Inter-Society Consensus (TASC) A (48%), seven TASC B (30%), five TASC C (22%), and no TASC D (0%). Of the bypasses, five originated from the distal SFA, five originated from the above knee popliteal artery, and 13 originated from the below knee popliteal artery. A significant majority of the patients (87%) were diabetic. No deaths, amputations, or early graft failures occurred during the perioperative period. The mean duration of follow-up was 40.8 months. By life-table analysis, the primary patency rate was 58% at 5 years. The primary assisted patency rate was 69% at 5 years. Of the seven interventions required to maintain patency, only one targeted the SFA. None of the graft failures could be specifically attributed to disease progression of the SFA. The 5-year limb salvage rate was 70% and the survival rate was 65%. Percutaneous SFA intervention in preparation for a distal origin graft is a useful and effective strategy in select patients. The durability appears comparable with distal origin grafts performed in the absence of an SFA intervention. This strategy provides a good option in the setting of both atherosclerotic SFA disease and limited autogenous conduit.

An updated meta-analysis of infrainguinal arterial reconstruction in patients with end-stage renal disease

A previous meta-analysis reported on the mid-term outcomes of infrainguinal bypass grafts in patients with critical limb ischemia and end-stage renal disease. Given the competing interest in endovascular procedures, the results of bypass surgery must be assessed as precisely as possible for future comparison. In this study, the original meta-analysis was refined and updated by increasing the number of studies reviewed, estimating primary graft patency, extending follow-up time, and investigating the problem of early amputation despite a patent graft. Studies published from 1987 through 2005 were identified from two electronic databases. Two investigators independently extracted the survival data from life tables, survival curves, and texts. Pooled survival curves were then constructed for graft patency, limb salvage, and patient survival according to a random-effects protocol for meta-analysis. Of 28 articles included, 18 reported amputation despite a patent graft in 84 (10%) out of 844 limbs, and 25 described a perioperative mortality of 88 (8.8%) out of 996 patients. The 5-year pooled estimate (SE) was 50.4% (15.4%) for primary patency, 50.8% (19.0%) for secondary patency, 66.6% (11.2%) for limb salvage, and 23.0% (11.7%) for patient survival. No publication bias was detected. Limb salvage can be achieved in most end-stage renal disease patients who undergo bypass surgery for critical ischemia, but survival is poor. To avoid early amputation despite a patent graft, bypass grafting should not be offered to patients with a great amount of tissue loss or extensive infection.

On the biology of saphenous vein grafts fitted with external synthetic sheaths and stents

Autologous saphenous vein is used as a conduit to bypass atherosclerotic lesions in both the coronary artery (coronary artery bypass graft surgery [CABG]) and in femoral arteries (infrainguinal bypass graft surgery [IIBS]). Despite the undoubted success and benefits of the procedures, graft failure occurs in 50% of cases within 10 years after surgery. A principal cause of late vein graft failure is intimal and medial hyperplasia and superimposed atherogenesis. Apart from lipid lowering therapy, no intervention has hitherto proved clinically effective in preventing late vein graft failure which clearly constitutes a major clinical and economic problem that needs to be urgently resolved. However, we have studied the effect of external synthetic stents and sheaths in pig models of vein into artery interposition grafting and found them to have a profound effect on vein graft remodelling and thickening. In this review, therefore, we will summarise the mechanisms underlying vein graft failure and how these stents influence these processes and the possible mechanisms involved as well as the application of these devices in preventing vein graft failure clinically.

Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli

Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft. Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms. The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.

Lipoplex gene transfer of inducible nitric oxide synthase inhibits the reactive intimal hyperplasia after expanded polytetrafluoroethylene bypass grafting

Intimal hyperplasia (IH) is most commonly the cause of graft occlusion in infrainguinal bypass grafting for arterial occlusive disease. We investigated the influence of nitric oxide on the IH of the arterial vessel wall at the region of prosthetic bypass anastomoses. Experiments were performed in 10 Foxhound dogs. We used a technique of inducible nitric oxide synthase (iNOS) overexpression by a non-virus-mediated, liposome-based iNOS gene transfer. The plasmid pSCMV-iNOS, which drives the expression of iNOS under control of the cytomegalovirus promoter, was complexed with cationic liposomes (lipoplexes). Segments of both carotid arteries were pretreated by intramural injection of a lipoplex solution by using an infiltrator balloon catheter (Infiltrator Drug Delivery Balloon System). In each dog, iNOS was administered at one side, and a control vector (pSCMV2) was administered at the contralateral side. Carotid arteries were ligated, and bypass grafts (expanded polytetrafluoroethylene, 6-mm, ring enforced) were implanted on both sides. The proximal and distal anastomoses (end-to-side fashion; running nonabsorbable sutures) were placed in the pretreated regions. After 6 months, the prostheses were excised, and the intimal thicknesses of 50 cross sections (orcein staining) of each anastomosis were measured planimetrically. The average reduction of the neointima thickness of the iNOS side in proximal anastomoses at the prosthetic wall, suture region, and arterial wall was 43%, 52%, and 81%, respectively. In distal anastomoses, the average reduction was 40%, 47%, and 52%, respectively. All differences of neointima thickness between the iNOS and control sides were statistically significant (Wilcoxon test; P < or = .05). Inducible NOS expression is an efficient approach for inhibition of IH. In contrast to earlier studies, which investigated the efficacy of gene therapeutic NOS expression at 3 to 4 weeks after intervention, the novelty of our findings is that a single local lipoplex-mediated transfection of the vascular wall with iNOS-expressing plasmids leads to a reduction of IH in a prosthetic in vivo model even after 6 months. Because all components can be manufactured under Good Manufacturing Practice conditions (the quality-management system of the European pharmaceutical industry based on ISO 9000), this approach is also amenable to human therapy.

Duplex Guided Balloon Angioplasty of Failing Infrainguinal Bypass Grafts

Objective To assess the results of angioplasty and stent placement under duplex guidance for failing grafts. Methods Over 22 months, 25 patients (72% males) with a mean age of 74±10 years presented to our institution with a failing infrainguinal bypass. The site of the most significant stenotic lesion was in the inflow in four cases, conduit in 18 cases and at the outflow in 11 cases. All arterial (20) or graft (13) entry sites cannulations were performed under direct duplex visualization. Duplex scanning was the sole imaging modality used to manipulate the guide wire and directional catheters from the ipsilateral CFA to a site beyond the most distal stenotic lesion. Selection and placement of balloons and stents were also guided by duplex. In 11 cases (33%), the contralateral CFA was used as the entry site and a standard approach (fluoroscopy and contrast material) was employed. Completion duplex exams were obtained in all cases. Results The overall technical success was 97% (32/33 cases). In only one case, the outflow stenotic lesion in the plantar artery could not be traversed with the guidewire due to extreme tortuosity. Overall local complications rate was 6% (two cases). One vein bypass pseudoaneurysm caused by rupture with a cutting balloon was repaired by patch angioplasty and one SFA pseudoaneurysm at the puncture site required open repair. Overall 30-day survival rate was 100%. Overall 6-month limb salvage and primary patency rates were 100 and 69%, respectively. Conclusions Duplex guided endovascular therapy is an effective modality for the treatment of failing infrainguinal arterial bypasses.

Die Angioplastie der distalen Anastomose und Run-off-Arterien bei verschlossenen infrainguinalen Bypässen

We investigated the clinical results of transluminal angioplasty performed through infrainguinal bypass grafts for stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in high risk patients and the influence of different parameters on limb salvage, primary and secondary patency rate. Between January 2001 and March 2005 we performed 49 transluminal angioplasties on stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in 49 (16 female, 23 male, mean age 71.1 years) patients with occluded infrainguinal bypass. 20 angioplasties occurred in the runoff arteries, 5 at the distal anastomosis and 24 at both locations at a median of 11.3 months (range 2-85 months) after infrainguinal bypass grafting). 20 procedures were on popliteal artery above the knee, 21 below the knee and 8 on crural arteries. Kaplan-Meier analysis showed a cumulative limb salvage of 87.6 and 76.4 % after 6 months and two years, respectively. Patients with gangrenous lesions had a 5 times higher risk of amputation (Cox-regression model). Primary and secondary patency rates were at 6 months 85.1 and 91.1 % respectively and were at one year 73.3 and 78.8 % respectively. Patients with end stage renal disease were in 4 times hazard to primary occlusion and patients with gangrenous lesions 5 times to secondary occlusion (Cox-regression model). Even if the long-term results of angioplasty on stenotic or occluded lesions at the distal anastomosis and/or in the runoff arteries are inferior to the results of surgical revisions reported in literature, angioplasty in high risk patients with absence af a vein may be the first line alternative intervention for limb salvage.

Invited commentary

Bosiers et al herein report the first clinical series of infrainguinal bypass with a new, heparin-bonded, expanded polytetrafluoroethylene (ePTFE) prosthesis. This option has now been added to the smorgasbord of options from which vascular surgeons may choose when performing infrainguinal bypass. The menu includes reversed, nonreversed, and in situ great and short saphenous vein; alternate (arm) vein; Dacron; heparin-bonded Dacron; human umbilical vein (HUV); Distaflo (Bard Peripheral Vascular, Inc, Tempe, Ariz) ePTFE; and standard ePTFE, to which one may add adjuncts such as a Miller cuff, St. Mary’s collar, Taylor patch, or distal arteriovenous fistula. Although this report is interesting and provocative, it represents at most a tantalizing tidbit on the smorgasbord of vascular grafts rather than a substantial main course. The study was conducted in a relatively low-risk group of patients and was limited by small sample size, short follow-up, and lack of a control group. Fifty-five of the 99 procedures were above-knee (AK) femoropopliteal (FP) bypasses, and 58 of the procedures were performed for claudication (Rutherford grade I, category 3); only 16 procedures were performed in patients with rest pain (grade II, category 4), and 26 bypasses were performed in individuals with minor tissue loss (category 5). Among 45 infrageniculate bypasses, the insertion site was the below-knee (BK) popliteal artery in 24 patients and a crural vessel in 21. Ten of 86 patients died during the first follow-up year, and 15 of 99 implanted grafts occluded during the first year after surgery, leaving small numbers of patients and grafts available for even short, 1-year follow-up. Reported, 1-year life-table primary patency rates were 84% for AK FP bypasses and 81% for BK FP grafts. The numbers were so small for the crural subgroup that the standard of error was >10% at both 6 and 12 months, making the Kaplan-Meier curve unreliable. Skeptics will note that almost any material performs well for the first 1 to 3 years in claudicants with an AK popliteal insertion site. At least three prospective, randomized trials have demonstrated equivalence between ePTFE and Dacron for AK FP bypass. Although a single study of 209 patients reported early improvement in FP graft patency for heparin-bonded Dacron compared with standard ePTFE at 3 years, by 5 years, results were equivalent. Randomized prospective trials have demonstrated that vein outperforms all prosthetic conduits for all infrainguinal insertion sites; while the demonstration of vein superiority in the AK position requires 3 to 5 years of follow-up, the superiority of vein over prosthetic has been readily demonstrated for BK FP and femorocrural bypasses with only 1 to 2 years of follow-up. A single study of PTFE with a Miller cuff for BK popliteal bypass reported dramatically improved 2-year patency (52% vs 29%) associated with the addition of a distal cuff. If the vascular surgeon of 2005 were to approach the infrainguinal graft smorgasbord and find that vein is unavailable, what conduit should he select? The present study will not help him reach a decision. Available in vitro animal studies suggest that heparin is detectable for up to 4 weeks on polyester Dacron grafts. Heparin activity has been reported to be measurable for up to 12 weeks on heparin-bonded ePTFE grafts. Whether this possibly longer duration of heparin activity confers increased thromboresistance as well as a patency advantage for heparin-bonded ePTFE grafts is uncertain. The clinical utility of this potentially promising off-the-shelf prosthesis will require prospective, randomized trials. Suitable control groups would include standard ePTFE, PTFE with a distal venous adjunct (cuff, collar, or patch), and perhaps ePTFE with a modified distal cuff such as Distaflo. Given the apparent aversion of vascular surgeons to prospective, randomized trials of infrainguinal bypass grafts, we may have to wait for quite a while before we know. Until then, the conduit choice in the absence of suitable vein remains a highly subjective matter of taste.

Haemodynamic Effect of Intermittent Pneumatic Compression of the Leg After Infrainguinal Arterial Bypass Grafting

Haemodynamic Effect of Intermittent Pneumatic Compression of the Leg After Infrainguinal Arterial Bypass Grafting

Infrainguinal Vein Bypass Graft Revision: Factors Affecting Long-term Outcome

Infrainguinal Vein Bypass Graft Revision: Factors Affecting Long-term Outcome

Outcome of Surgical and Endoluminal Intervention for Infrainguinal Bypass Anastomotic Strictures

The objective of this study was to compare the outcomes of percutaneous transluminal angioplasty (PTA) versus open surgical repair of anastomotic strictures affecting infrainguinal bypasses. Anastomotic strictures affecting 39 bypasses in 36 patients were identified among 593 consecutive infrainguinal arterial reconstructions performed between 1994 and 2004. The mean age of affected patients was 65 +/- 2 years (range: 61 to 101 years). The original bypasses, with vein grafts outnumbering prosthetic grafts 2 to 1, were performed for acute (5%) and chronic (54%) limb-threatening ischemia, disabling claudication (28%), or popliteal aneurysms (13%). Anastomotic strictures were first recognized an average of 16 +/- 3 months (range 2 to 92 months) postoperatively. Strictures affected the distal anastomosis in 62% of cases and the proximal anastomosis in 38%. Primary patency, assisted primary patency, secondary patency, and limb salvage were assessed following PTA or open surgical repair of the strictures. Anastomotic strictures were detected following acute (41%) and chronic (18%) limb-threatening ischemia, claudication (13%), or during routine graft surveillance (28%) in asymptomatic patients. Graft thrombosis, occurring in 51% of patients at the time of presentation, was not affected by the site of anastomotic stricture, although prosthetic grafts were affected more than vein grafts (92% vs 31%). Interventions included PTA (67%) and conventional open procedures (33%). The latter included vein patch angioplasty, short interposition grafts, and redo bypasses. The stricture site and bypass material used in the original revascularization did not affect reintervention patency rates. Sixteen (62%) of the endovascular procedures were performed on a graft presenting with thrombosis, while only 4 (31%) were initially treated with operative therapy. Treatment of thrombosed grafts resulted in an 18-month patency of 32% compared to an 80% patency in treating grafts that were not occluded at the time of presentation (p < 0.05). No anastomotic stricture repaired operatively required reintervention, whereas 42% of those treated by PTA required a mean of 1.3 additional reinterventions (p < 0.03). Anastomotic strictures affecting infrainguinal bypass grafts contribute to low patency rates. Outcomes can be significantly improved if these strictures are identified before graft thrombosis. Open surgical repair, compared to PTA, provides improved graft function as evident by fewer subsequent interventions required to maintain graft patency.

Nachbehandlung der pAVK nach Interventionen und Gefäßchirurgie mit Antikoagulanzien und Thrombozytenfunktionshemmern

Platelet inhibitors and anticoagulants are used in the longterm treatment after successful infrainguinal bypass grafts as well as endovascular revascularisation procedures. However, evidence of the usefulness of these therapies is limited with respect to efficiency (patency rate, mortality) and safety (bleeding tendency) concerning these indications. Sufficient data are only available for acetylsalicylic acid treatment after implantation of prosthetic bypass grafts, the data basis for the use of antithrombotic medication in venous bypass grafts or following successful balloon angioplasty with or without stent implantation is, however, inconclusive. The recommendation for lifelong therapy with acetylsalicylic acid after infrainguinal bypass surgery and endovascular treatment is based mainly on the concept of prophylactic treatment of manifest atherosclerotic disease.