Endovascular salvage of distal infrainguinal bypass anastomotic stenosis following thrombectomy using a heparin-bonded covered stent

Summary: Background: To evaluate the outcomes of occluded lower limb bypass grafts treated by surgical thrombectomy and heparin-bonded covered stent graft deployment for distal anastomotic stenosis. Materials and methods: This was a single-centre, retrospective, single-arm study including consecutive patients with occluded infrainguinal bypass grafts treated between January 2020 and December 2024 with surgical thrombectomy followed by endovascular reconstruction of the distal anastomosis using a heparin-bonded covered stent graft. The primary endpoint was primary patency. Secondary endpoints were secondary patency, freedom from target lesion revascularization (TLR), mortality, and major amputation. Results: Thirty-two patients were included. Most patients presented with acute limb ischaemia (59.4%), followed by chronic limb-threatening ischaemia and claudication. Twenty-nine patients (90.6%) had a previously placed prosthetic bypass. Median hospital stay was 11 days (9–21). Intensive care unit treatment was required in 31%, while in-hospital morbidity and mortality were 34% and 9%, respectively. Primary patency at 3, 6, and 12 months was 55%, 49%, and 33%. Secondary patency at 12 months was 42%, freedom from TLR 43%, survival 80%, and freedom from major amputation 89%. Conclusions: In this high-risk cohort, surgical thrombectomy followed by covered stent graft reconstruction of distal anastomotic stenosis was associated with limited primary patency and frequent reintervention. These findings should be interpreted as descriptive outcomes of a complex hybrid bypass salvage strategy rather than isolated covered stent graft performance.