Is Balloon Angioplasty Indicated for “Short” Stenoses of Failing Vein Grafts?

Previous reports have suggested “short” focal stenoses in peripheral vein grafts (PVGs), namely less than 2 cm long, can be successfully balloon dilated with good long-term patency rates. We questioned if enthusiasm for balloon angioplasty of these lesions in failing PVGs is warranted. Between August 1, 1993 and December 31, 1996, we performed balloon angioplasty of “short” stenoses in 19 PVGs in 16 patients. Bypasses included seven femoropopliteal, six femorotibial, and six popliteal-tibial or -pedal PVGs. All bypasses were originally performed for limb salvage. Single lesions were present in 13 grafts and two lesions in six grafts. Ten lesions were located at an anastomosis, 10 were located in the body of the graft, and five were peri-anastomotic. Fifteen procedures were performed percutaneously. Four angioplasties were performed using an open surgical approach because a percutaneous attempt failed in one case and three grafts were either in situ or tunneled subcutaneously making them easy to expose. Completion arteriogram documented excellent initial results in all 19 grafts. Cumulative one-year primary patency rate was 39%. The assisted primary patency rate at one year was 73%. Only five grafts remained patent 7–20 months (mean, 10 months) during follow-up without requiring further revision. One patient died with a patent graft 23 months post-balloon angioplasty. Complications included two hematomas following a percutaneous approach that required surgical repair. These results when compared to publications detailing patency following surgical revision suggest that balloon angioplasty of “short” stenoses less than 2 cm long in PVGs may be better treated by surgical revision. We reserve balloon angioplasty for “short” lesions when surgical revision is associated with inordinate difficulty such as a scarred groin wound in an obese patient.