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DES improve patency in treatment of infrainguinal bypass graft stenosis

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HOLLYWOOD, Fla. — Treatment of infrainguinal bypass graft stenosis with drug-eluting stents is feasible, safe and may be more effective than paclitaxel-coated balloon angioplasty or plain old balloon angioplasty, a speaker said at the International Symposium on Endovascular Therapy.

“Stenosis of the infrainguinal bypass graft occurs in up to 20% [of cases]. … Drug-eluting stents offer new technology that is not currently well-described for this indication,” Christopher J. Abularrage, MD, FACS, director of the Diabetic Foot and Wound Clinic and associate professor of surgery at Johns Hopkins Medicine, told the audience here.

To gather more information on use of DES, Abularrage and colleagues performed a single-center, retrospective analysis comparing clinical outcomes of DES vs. percutaneous cutting balloon angioplasty vs. plain old balloon angioplasty (POBA) for treatment of infrainguinal bypass graft stenosis over a 6-year period.

The analysis included 34 patients (mean age, 64 years; 52% men; 50% black). Patients presented with various risk factors, including hypertension (94%), diabetes (63%) and CAD (51%). HF and chronic kidney disease were also common. More than 86% of patients had at least two comorbidities.

Data from treatment of 61 lesions in 36 infrainguinal bypass grafts were reported. DES was the preferred strategy in nine (15%) of the 61 lesions, percutaneous cutting balloon in 20 (33%) and POBA in 32 (52%). Tissue loss was the primary indication for initial bypass (56%), followed by claudication (23%).

The primary outcome — stenosis-free patency of the treated lesion — was higher after treatment with DES compared with percutaneous cutting balloon or POBA, according to Kaplan-Meier analysis. One-year primary patency was 100% with DES vs. 62% with percutaneous cutting balloon vs. 50% with POBA (P = .03), Abularrage said during the presentation.

Limb salvage at 1 year was similar between the groups, according to Kaplan-Meier analysis: 100% with DES and POBA vs. 90% with percutaneous cutting balloon (P = .22).

In other results, among the treated lesions:

• proximal anastomosis was 30% overall: 20% with DES, 33% with percutaneous cutting balloon and 31% with POBA;
• mid-bypass was 29% overall: 30% with DES, 24% with percutaneous cutting balloon and 31% with POBA; and
• distal anastomosis was 41% overall: 50% with DES, 43% with percutaneous cutting balloon and 38% with POBA (P = .91 for all).

The overall rate of technical success was 100%. No periprocedural complications were observed.

Abularrage called for further research on optimal device use for treatment of infrainguinal bypass graft stenosis.

“Additional studies comparing long-term clinical outcomes following DES, [percutaneous cutting balloon] and other endovascular treatment modalities are needed in order to optimize patency rates of failing bypass grafts,” he said. – by Katie Kalvaitis

Reference:

Abularrage CJ. Concurrent Session I: Peer Reviewed Abstract Presentations. Presented at: International Symposium on Endovascular Therapy; Feb. 4-8, 2017; Hollywood, Fla.

Disclosure: Abularrage reports no relevant financial disclosures.