Endovascular revascularization of native arteries after bypass graft failure in patients with critical limb ischemia

The aim of this study was to evaluate the success rate of endovascular revascularization of native infrainguinal arteries following the occlusion of bypass grafts. Materials and Methods: We performed a retrospective review of patients with critical limb ischemia (CLI) who underwent endovascular recanalization of chronic occluded native arteries after failure of femoropopliteal bypass grafts between 2014-2017. Data collected included patient demographics, site of occluded arteries, type and number of bypasses performed, and details of endovascular revascularization. Technical success, freedom from primary amputation, and hospitalization days were recorded. Results: Fourteen male patients with 15 limbs, (mean age 72 years ±6.2), were evaluated. Six limbs presented with Rutherford class 4, 6 with Rutherford class 5, and 3 limbs with Rutherford class 6. All arterial lesions were in the femoropopliteal segment. Thirteen were classified as TASC II class D and two as class C. Eleven limbs had undergone 1 surgical bypass, 3 limbs had 2, and 1 limb had 3 bypasses. The native vessels were occluded for a mean of 91.9 months (±68.7 months). Technical success was achieved in all cases, with stent placement in 14 out of the 15 limbs. Mean follow-up was 14.1 months. One patient underwent amputation of the affected limb. Conclusion: Revascularization of native femoropopliteal arteries after failure of bypass surgery is feasible and should be considered as a treatment option before limb amputation.