Adam W. Beck, MD, Erin H. Murphy, MD, Jennie A

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Presentation transcript:

Aortic reconstruction with femoral-popliteal vein: Graft stenosis incidence, risk and reintervention Adam W. Beck, MD, Erin H. Murphy, MD, Jennie A. Hocking, MPAS, PA-C, Carlos H. Timaran, MD, Frank R. Arko, MD, G. Patrick Clagett, MD Journal of Vascular Surgery Volume 47, Issue 1, Pages 36-44 (January 2008) DOI: 10.1016/j.jvs.2007.08.035 Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, Kaplan-Meier curves demonstrating primary and assisted-primary patency up to >100 months after the neoaortoiliac system (NAIS) procedure. B, Patient survival after NAIS. The tabular life table refers to primary and assisted primary patency as well as survival. Journal of Vascular Surgery 2008 47, 36-44DOI: (10.1016/j.jvs.2007.08.035) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 2 Angiogram images demonstrate a right proximal neoaortoiliac system (NAIS) limb stenosis (left image; arrow) diagnosed 17 months after the original reconstruction. Balloon angioplasty (center image) was performed with an 8 mm balloon inflated to 16 atmospheres of pressure with resulting graft rupture (right image; arrow). This complication was managed with covered stent placement and required no further intervention. Journal of Vascular Surgery 2008 47, 36-44DOI: (10.1016/j.jvs.2007.08.035) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 3 This patient required two separate interventions for neoaortoiliac system (NAIS) limb stenoses occurring at unrelated locations in the grafts. The left image demonstrates the first stenosis and its management with angioplasty/stent at 13.5 months after NAIS. At 32.5 months after NAIS, the same patient required a second intervention for a stenosis at the aorto-FPV limb (Right; arrow). Journal of Vascular Surgery 2008 47, 36-44DOI: (10.1016/j.jvs.2007.08.035) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 4 Kaplan-Meier curves demonstrating primary patency of vein grafts >7.2 mm (upper line) and small vein grafts (lower line). Small preoperative vein graft diameter (<7.2 mm) was found to be an independent risk factor for stenosis (P < .006) in a survival analysis. Journal of Vascular Surgery 2008 47, 36-44DOI: (10.1016/j.jvs.2007.08.035) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 5 (Left) Classification and regression tree used to determine patients at high risk for stenosis. The bottom left grey oval denotes a high risk group having both small grafts and a personal history of coronary artery disease (CAD). On the right is a Kaplan-Meier analysis demonstrating revision-free survival after neoaortoiliac system (NAIS) in high-risk patients (those with both CAD and small grafts) vs low-risk patients (those with one or neither risk factor). Journal of Vascular Surgery 2008 47, 36-44DOI: (10.1016/j.jvs.2007.08.035) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 6 All stenoses were noted to involve a short segment of the neoaortoiliac system (NAIS) limb. This image demonstrates a preoperative three dimensional computed tomographic image of a short-segment NAIS stenosis (arrow) noted at 11 months after the original reconstruction. This was managed with an open saphenous vein patch angioplasty. Journal of Vascular Surgery 2008 47, 36-44DOI: (10.1016/j.jvs.2007.08.035) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions