Interventions in infrainguinal bypass grafts.

The long-term success of infrainguinal bypass grafts depends on meticulous surgical technique and a periodic program of postoperative surveillance. Duplex scanning is the method of choice for the detection of stenotic lesions that threaten graft patency. As an alternative to surgery, PTA is gaining increasing acceptance for the treatment of non-recurrent, short, and single stenotic lesions, despite somewhat controversial opinions. The initial technical success rates for PTA were reported to be up to 100%, and a 5-year primary assisted patency rate of up to 65% has been achieved. Some authors favorize intra-arterial infusion of fibrinolytic agents for the treatment of bypass graft occlusion with technical success rates of up to 92%. In addition to a reduced trauma compared to surgical thrombectomy, of the venous wall the advantage of thrombolytic therapy is clot lysis in run-off vessels, and uncovering of the stenotic lesions. This stenosis may then be treated by an endovascular or surgical approach.