Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery, Kalmar Hospital, Kalmar, Sweden.
Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
Ann Vasc Surg. 2021 Jul;74:339-343. doi: 10.1016/j.avsg.2020.12.015. Epub 2021 Jan 27.
Treatment of chronically occluded infrainguinal venous bypass grafts in patients presenting with recurrent chronic limb threatening limb ischemia (CLTI) represent a clinical challenge. Recent case reports have suggested the use of endovascular recanalization techniques without preceding thrombolysis. This study assesses feasibility and mid-term outcomes of this technique.
A retrospective review of 5 consecutive patients (3 men, 2 women, mean age 70 ± 5 years) presenting with chronic venous bypass graft occlusion and recurrence of CLTI during 1 year was performed. Patients were treated with relining of the bypass grafts. Patients were followed up at median 26 (6-36) months. All patients were treated successfully with restoration of flow in the grafts using recanalization and relining technique without thrombolysis. In 4 patients, a Viabahn stentgraft (SG) was used with the addition of interwoven nitinol stents (INS) in 3. In 1 patient, the graft was treated with INS without the addition of a stentgraft. No peripheral embolization was encountered during the procedures. One patient occluded the relined grafts after 6 months. The remaining 4 grafts were all patent at 24-month follow-up. A total of 6 reinterventions (in 3 patients) were performed to reach 80% secondary patency.
This case series demonstrate feasibility and promising mid-term results, from relining of chronically occluded infra-inguinal venous bypass grafts using stent grafts, interwoven and bare-metal stents without preceding thrombolysis. The technique could be an alternative treatment option in the treatment of these challenging cases.
在患有复发性慢性肢体威胁性肢体缺血（CLTI）的患者中，治疗慢性闭塞的下肢静脉旁路移植术是一个临床挑战。最近的病例报告表明，在没有溶栓的情况下，可以使用血管内再通技术。本研究评估了该技术的可行性和中期结果。
对 5 例连续患者（3 名男性，2 名女性，平均年龄 70 ± 5 岁）进行了回顾性分析，这些患者在 1 年内出现慢性静脉旁路移植术闭塞和 CLTI 复发。患者接受了旁路移植术的再衬治疗。中位随访时间为 26 个月（6-36 个月）。所有患者均成功地通过再通和再衬技术治疗，无需溶栓即可恢复移植血管的血流。在 4 例患者中，使用 Viabahn 支架（SG），其中 3 例加用编织型镍钛合金支架（INS）。在 1 例患者中，仅用 INS 治疗，未加支架。在手术过程中未发生外周栓塞。1 例患者在 6 个月后再闭塞。其余 4 个移植物在 24 个月的随访中均保持通畅。共有 6 例（3 例患者）需要再次干预以达到 80%的二级通畅率。
本病例系列研究表明，在没有溶栓的情况下，使用支架、编织和裸金属支架再衬慢性闭塞的下肢静脉旁路移植术是可行的，且中期结果有一定的前景。该技术可能是治疗这些挑战性病例的一种替代治疗选择。
