Efficacy of thrombolysis in infrainguinal bypass grafts

The initial outcome of a consecutive series of 43 intra-arterial urokinase infusions for thrombosed infrainguinal grafts in 37 patients was analyzed. There was an 88% (38/43) technical success rate (complete clot lysis) and a 74% (32/43) clinical success rate. Complications occurred in 10 patients (...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1991-02, Vol.83 (2 Suppl), p.I99-105
Main Authors: Sullivan, K L, Gardiner, Jr, G A, Kandarpa, K, Bonn, J, Shapiro, M J, Carabasi, R A, Smullens, S, Levin, D C
Format: Article
Language:English
Subjects:
Aged
Blood Vessel Prosthesis
Female
Femoral Artery
Graft Occlusion, Vascular - drug therapy
Humans
Leg - blood supply
Life Tables
Male
Polytetrafluoroethylene
Popliteal Artery
Streptokinase - therapeutic use
Thrombolytic Therapy
Thrombosis - drug therapy
Urokinase-Type Plasminogen Activator - therapeutic use
Vascular Patency
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Summary:The initial outcome of a consecutive series of 43 intra-arterial urokinase infusions for thrombosed infrainguinal grafts in 37 patients was analyzed. There was an 88% (38/43) technical success rate (complete clot lysis) and a 74% (32/43) clinical success rate. Complications occurred in 10 patients (23%) and were related to bleeding in four patients (9%). Patient age, graft age, location, material, and the duration of occlusion did not significantly influence the initial outcome, although there was a trend toward a higher bleeding complication rate among grafts less than or equal to 1 month of age at the time of thrombolysis. A second group of 43 infrainguinal grafts successfully recanalized using regional infusions of thrombolytic agents were followed for long-term patency. This group included 32 grafts successfully treated with urokinase and 11 grafts recanalized with streptokinase. By life-table analysis there was a 55.6% 1-year patency, which fell to 42.4% at 4 years. Vein grafts had significantly (p = 0.01) better long-term patency than prosthetic grafts (69.3% versus 28.6% at 30 months). Grafts with flow-limiting lesions identified and corrected by angioplasty or surgery also had significantly (p = 0.01) better long-term patency than those without such lesions (79.0% versus 9.8% at 2 years). Based on the results of our study compared with a survey of long-term results following secondary surgical procedures for thrombosed infrainguinal grafts, thrombolysis can be recommended in several circumstances. Thrombolysis is indicated for thrombosed vein grafts or when thrombus is present in distal runoff vessels. Thrombosed prosthetic grafts should be replaced by autogenous vein grafts whenever possible.
ISSN:0009-7322
1524-4539