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Stent Graft Relining Of Occluded Infrainguinal Great Saphenous Vein Bypass Grafts
Christopher F. Tanga, DO1, Mariel Rivero, MD2, Hasan H. Dosluoglu, MD2.
1University at Buffalo, Buffalo, NY, USA, 2VA Western New York, Buffalo, NY, USA.

OBJECTIVES: Up to one-third of patients with infrainguinal great saphenous vein (GSV) bypass require intervention for restenosis or occlusion. Failure rates approach 70% after reintervention. Balloon angioplasty with plain balloon and cutting balloon have been reported for salvage of GSV bypass grafts. Relining the entire bypass graft with nitinol stent or stent graft (Viabahn) has been reported for salvaging graft failures with single case reports and no follow-up. The goal of this study is to present the frequency and midterm outcomes of GSV bypasses requiring stent graft relining for salvage.
METHODS: All patients with infrainguinal GSV bypass between 6/01-12/19 requiring reintervention were reviewed. Those with Viabahn relining were analyzed for early and late outcomes.
RESULTS: Of 294 patients with infrainguinal GSV bypass, 59 (20%) required intervention for salvage [41 for stenosis (14%); 18 for occlusion (6%)]. Viabahn relining of the GSV graft was performed in 5 patients with failed GSV bypass (2 rest pain, 2 tissue loss, one claudication) 1, 3, 8, 78 and 84 months after the initial bypass (3 femoral-to-below-knee popliteal, 1 femoral-to-above-knee popliteal, 1 femoral-anterior tibial), two of whom had previous interventions for restenosis. Three had thrombolysis followed by relining, two had focal proximal occlusions with diffuse stenosis which ruptured during balloon angioplasty. Mean follow-up was 2612 months (8-41 months) after relining. One remained patent at 41 months, one occluded at 18 months without reintervention. Two reoccluded at 4 and 9 months requiring thrombectomy and thrombolysis; one became infected at 1 month requiring a new bypass. All patients had limb salvage. Two died 22 and 27 months after relining from unrelated health issues. CONCLUSIONS:
Failed and threatened GSV bypass grafts can be successfully salvaged with stent graft relining. Limb salvage is attainable but most will require repeat interventions to maintain patency. Stent graft relining should be considered for thrombosed GSV bypasses and where diffuse stenosis is present or multiple reinterventions are required to maintain patency.

Summary of Viabahn Relining Cases
Bypass*Intervention before reliningIndication for reliningMonths to relineIntervention on relined graftMonths from reline to reintervention
Fem-BK popnoneTissue loss3Thrombolysis with distal stent extension4
Fem-BK popThrombolysis before reliningTissue loss1Infected distal anastomosis, ligated and new fem-PT bypass1; died at 22 months
Fem-AK popDCB; Thrombolysis before reliningClaudication84NoneNo reintervention; patent at 41 months
Fem-ATAngioplastyRest Pain78Non; occluded 18 months later without symptomsDied at 27 months
Fem-BK popThrombolysis before reliningRest pain8Thrombolysis x 29 and 29 months
*Great saphenous vein bypass: Fem-Femoral, BK-Below Knee, AK-Above Knee, pop-popliteal, pt-posterior tibial, DCB-drug coated balloon


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