Cutting Balloon Angioplasty of Autogenous Infrainguinal Bypasses: Short Term Safety and Efficacy

Robert Garvin, MD, Thomas Reifsnyder, MD, Steven Leers, MD, Gordon McLean, MD and Richard Foster, MD
Western Pennsylvania Hospital, Pittsburgh, PA, Johns Hopkins University, Baltimore, MD and University of Pittsburgh Medical Center, Pittsburgh, PA

Objective(s): To evaluate the short term safety and efficacy of cutting balloon angioplasty for the treatment of stenotic lesions that threaten the patency of autogenous infrainguinal bypasses.
Methods: A chart review was performed of patients undergoing cutting balloon angioplasty of autogenous infrainguinal bypasses from July 2002 to February 2006. From the time of bypass implantation all patients participated in a surveillance protocol that included duplex scanning of the entire bypass, including measurements of peak systolic graft velocity (PSV), ankle brachial index (ABI), and toe pressure (TP). Failing bypasses were evaluated with digital subtraction angiography. Cutting balloon angioplasty was used to treat areas of graft stenosis. Pre-procedural and post-procedural non-invasive results were recorded for PSV, ABI, and TP. Changes in non-invasive measurements were recorded as well as peri-procedural complications and graft patency.
Results: One-hundred cutting balloon angioplasties were performed on 71 lower extremity bypasses in 69 patients. There were 38/69 (55%) men and 31/69 (45%) women with an average age of 71 years (range 45-97). Bypasses included: 13/71 femoral-popliteal (18%), 45/71 femoral-tibial or pedal (64%), and 13/71 popliteal-distal (18%). Mean pre-procedure non-invasive values included: PSV at graft stenosis 384 + 133 cm/second, ABI 0.59 + 0.3, and TP 35 + 32 mmHg. Mean post-procedure non-invasive values included: PSV at angioplasty site 126 + 55 cm/second, ABI 0.89 + 0.2, and TP 64 + 33 mmHg. Following cutting balloon angioplasty the maximal PSV velocity decreased by 64%, while the ABI improved by 0.30 and the TP improved by 28 mmHg. At a median follow up of 9 months, graft patency was 68/71 (96%) and limb salvage was 68/71 (96%). There were 9/100 (9%) procedural complications including 4 graft ruptures, 2 peri-graft hematomas, 2 graft dissections, and 1 graft thrombosis. No complications resulted in the need for emergent surgery; however, one complication necessitated elective open bypass revision.
Conclusions: The use of cutting balloon angioplasty is both a relatively safe and effective option for treating stenoses of autogenous infrainguinal bypasses.