الفهرس Only 14 pages are availabe for public view
 |  | from | 113 |  |  |
| | | from | 113 | | |
Abstract
It is well known by vascular surgeons that early re-operations may occur as often as in one patient in ten. It is also common knowledge that repeated surgery at a later date, either as redo procedure or as another intervention, may become necessary in patients who have had a previous vascular procedure. The impact of reoperations, both for the distribution of resources and in clinical decision making, has also been addressed. However, most available reports on the occurrences of these events are either limited to the immediate postoperative period or concern only selected procedures
Graft failure could be classified as early (<30 days) or late (>30 days). Operative technical errors are the commonest causes of early graft failures while progression of atherosclerosis and development of intimal hyperplasia are often the cause of late graft occlusion
Despite continued advances in vascular surgical techniques and the improvement in infraingiuinal bypass graft patency, thrombosis of femoropopliteal and femorotibial bypass grafts remains a distressing and challenging problem for all vascular surgeons. Early graft failure has been reported in 5% to 20% of cases, whereas intermediate to late graft failure has occurred in 20% to 50% of cases. Thrombosis of infrainguinal bypass grafts usually results in a recurrence of ischemic symptoms ranging from claudication to limb-threatening ischemia
Approximately 20% of lower extremity vein grafts (LEVGS) require revision to maintain graft patency. Excellent assisted primary patency can be maintained with an aggressive policy of postoperative duplex surveillance and graft revision. Occasionally, multiple LEVG revisions may be necessary. The characteristics of recurrent LEVG lesions and the patency achieved after multiple revisions have not been reported
The management of occluded prosthetic grafts is complex and represents a challenge for the vascular surgeon. The risk of amputation after failed above-knee prosthetic bypass is high. Occluded femoropopliteal prosthetic grafts may be re-opened either by graft thrombectomy or thrombolysis. Cases with underlying inflow, outflow or anastomotic stenosis may be treated with patch angioplasty. Other treatment options in these patients are conservative, a new arterial reconstruction or amputation