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Cutting Balloon Percutaneous Transluminal Angioplasty for Salvage of Lower Limb Arterial Bypass Grafts: Feasibility¹

¹ From the Department of Diagnostic Radiology, St George’s Hospital, London, England. From the 2000 RSNA scientific assembly. Received April 16, 2001; revision requested June 2; revision received August 15; accepted September 7. Address correspondence to C.E., Department of Radiology, Klinikum Rechts der Isar, Ismaninger Strasse 22, D-81675 Munich, Germany (e-mail: cengelke@hotmail.com).

PURPOSE: To evaluate the feasibility of cutting balloon percutaneous transluminal angioplasty (PTA) for treatment of neointimal hyperplasia in peripheral arterial bypass grafts.

MATERIALS AND METHODS: Fifteen consecutive patients (six women, nine men; age range, 57–89 years; mean age, 71 years) were treated with cutting balloon PTA for 16 anastomotic stenoses after infrainguinal bypass (prosthetic grafts, seven patients; prosthetic-vein composite grafts, two; venous grafts, five; and ileofemoral stent-graft, one). Cutting balloon PTA was followed by conventional PTA to improve anastomotic diameter. Patients with stenotic vein grafts underwent cutting balloon PTA after failed conventional PTA; the other patients were treated primarily with cutting balloon PTA. Criteria for success were a lumen diameter improvement of greater than 50% or residual stenosis of 20% or less. Follow-up was performed with color duplex ultrasonographic surveillance. Patency rates and durations were calculated with Kaplan-Meier survival curves and log-rank statistics.

RESULTS: Attempted conventional PTA (n = 6) prior to cutting balloon PTA was unsuccessful. Cutting balloon PTA was technically successful in 15 (94%) of 16 lesions, without clinical complications. Two local restenoses and one graft occlusion occurred between 5 and 7 months. The cumulative 6-month primary and secondary graft patency rates were 84% and 92%, respectively. At 12 and 18 months, they were 67% (95% CI: 0.34, 0.86) and 83% (95% CI: 0.48, 0.96), respectively; mean follow-up was 10.0 months.

CONCLUSION: Cutting balloon PTA proved feasible for treatment of resistant peripheral arterial bypass graft stenosis, commonly caused by neointimal hyperplasia, with excellent technical success. Short-term patency with this technique appears to be superior to that with conventional PTA, and it compares well with patency of atherectomy for salvage of infrainguinal bypass grafts.

© RSNA, 2002

Index terms: Arteries, restenosis • Arteries, transluminal angioplasty • Grafts, interventional procedures

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