TY - JOUR

T1 - Feasibility of Percutaneous Ultrasound Guided Intervention with Direct Access in Failing Infrainguinal Vein Bypass Grafts

AU - Lugovski, Staša

AU - Pedersen, Brian Lindegaard

AU - Riazi, Hadi

AU - Græbe, Martin

N1 - Funding Information: The authors would like to thank the department's EVAs (endovascular assistants), who are all highly experienced diagnostic vascular ultrasound technicians. The department has an ongoing funded research collaboration with Philips Ultrasound. Publisher Copyright: © 2023 Elsevier Inc.

PY - 2023

Y1 - 2023

N2 - Background: Patients with infrainguinal venous bypass grafts are at risk of graft stenosis leading to thrombosis and failure of the graft conduit. When primary assisted reintervention is needed, a common first choice of treatment is percutaneous angioplasty using fluoroscopy and digital subtraction angiography (DSA). We investigated whether percutaneous ultrasound-guided intervention (PUSGI) is feasible for such endovascular reinterventions. Methods: In this retrospective observational study (feasibility study), we included patients with ultrasound evidence of significant stenosis in below-the-knee vein grafts in the lower extremities. Inclusion period was 18 months. Reinterventions were disrupted by performing PUSGI in between traditional DSA. Perioperative success was defined as no sign of residual stenosis, stenosis at the access point in the vein, or need for further fluoroscopy guided intervention. Patient follow-up was conducted 6 weeks after the intervention. Patency of the procedure was defined as no disease recurrence or signs of ultrasonographic restenosis at follow-up. Results: PUSGI was performed in 17 patients referred for reintervention with imminent failing grafts (12 men, 5 women, age range 52–82 years). PUSGI alone was performed successfully in 10 out of 17 patients (59%). The remaining 7 patients underwent successful revascularization with PUSGI in combination with DSA-guided angioplasty. Periprocedural complications occurred in 4 patients. Two of 17 patients had occluded grafts at 6 weeks of follow-up. No PUSGI access site stenoses in grafts were observed. Conclusions: Percutaneous ultrasound-guided reintervention in peripheral vein bypass disease is feasible for selected patients. The study provides insight to qualitative criteria of eligibility for PUSGI in such reinterventions with direct conduit access.

AB - Background: Patients with infrainguinal venous bypass grafts are at risk of graft stenosis leading to thrombosis and failure of the graft conduit. When primary assisted reintervention is needed, a common first choice of treatment is percutaneous angioplasty using fluoroscopy and digital subtraction angiography (DSA). We investigated whether percutaneous ultrasound-guided intervention (PUSGI) is feasible for such endovascular reinterventions. Methods: In this retrospective observational study (feasibility study), we included patients with ultrasound evidence of significant stenosis in below-the-knee vein grafts in the lower extremities. Inclusion period was 18 months. Reinterventions were disrupted by performing PUSGI in between traditional DSA. Perioperative success was defined as no sign of residual stenosis, stenosis at the access point in the vein, or need for further fluoroscopy guided intervention. Patient follow-up was conducted 6 weeks after the intervention. Patency of the procedure was defined as no disease recurrence or signs of ultrasonographic restenosis at follow-up. Results: PUSGI was performed in 17 patients referred for reintervention with imminent failing grafts (12 men, 5 women, age range 52–82 years). PUSGI alone was performed successfully in 10 out of 17 patients (59%). The remaining 7 patients underwent successful revascularization with PUSGI in combination with DSA-guided angioplasty. Periprocedural complications occurred in 4 patients. Two of 17 patients had occluded grafts at 6 weeks of follow-up. No PUSGI access site stenoses in grafts were observed. Conclusions: Percutaneous ultrasound-guided reintervention in peripheral vein bypass disease is feasible for selected patients. The study provides insight to qualitative criteria of eligibility for PUSGI in such reinterventions with direct conduit access.

U2 - 10.1016/j.avsg.2023.05.028

DO - 10.1016/j.avsg.2023.05.028

M3 - Journal article

C2 - 37263415

AN - SCOPUS:85162877927

VL - 97

SP - 375

EP - 381

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

ER -