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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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| Published in: | Circulation (New York, N.Y.) N.Y.), 1991-02, Vol.83 (2 Suppl), p.I99-105 |
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| Main Authors: | , , , , , , , |
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| Language: | English |
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| container_end_page | 105 |
| container_issue | 2 Suppl |
| container_start_page | I99 |
| container_title | Circulation (New York, N.Y.) |
| container_volume | 83 |
| creator | Sullivan, K L Gardiner, Jr, G A Kandarpa, K Bonn, J Shapiro, M J Carabasi, R A Smullens, S Levin, D C |
| description | 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. |
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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.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>PMID: 1991406</identifier><language>eng</language><publisher>United States</publisher><subject>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</subject><ispartof>Circulation (New York, N.Y.), 1991-02, Vol.83 (2 Suppl), p.I99-105</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1991406$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sullivan, K L</creatorcontrib><creatorcontrib>Gardiner, Jr, G A</creatorcontrib><creatorcontrib>Kandarpa, K</creatorcontrib><creatorcontrib>Bonn, J</creatorcontrib><creatorcontrib>Shapiro, M J</creatorcontrib><creatorcontrib>Carabasi, R A</creatorcontrib><creatorcontrib>Smullens, S</creatorcontrib><creatorcontrib>Levin, D C</creatorcontrib><title>Efficacy of thrombolysis in infrainguinal bypass grafts</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>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.</description><subject>Aged</subject><subject>Blood Vessel Prosthesis</subject><subject>Female</subject><subject>Femoral Artery</subject><subject>Graft Occlusion, Vascular - drug therapy</subject><subject>Humans</subject><subject>Leg - blood supply</subject><subject>Life Tables</subject><subject>Male</subject><subject>Polytetrafluoroethylene</subject><subject>Popliteal Artery</subject><subject>Streptokinase - therapeutic use</subject><subject>Thrombolytic Therapy</subject><subject>Thrombosis - drug therapy</subject><subject>Urokinase-Type Plasminogen Activator - therapeutic use</subject><subject>Vascular Patency</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1991</creationdate><recordtype>article</recordtype><recordid>eNotj0tLxDAUhYMoYx39CUJX7gppcpvHUobxAQNuZl-S9KZG-jJpF_33Fiwc-DjwceDckKysGBRQcX1LMkqpLiRn7J48pPSzVcFldSCHUusSqMiIPHsfnHFrPvp8_o5jb8duTSHlYdjiowlDu4TBdLldJ5NS3kbj5_RI7rzpEj7tPJLr2_l6-iguX--fp9dL0TKm50JJCci1q5zSyHmJQnknlMFGiIZZ49Erb6mUSBs0AKyprAAJVKMqOeVH8vI_O8Xxd8E0131IDrvODDguqVYUOICATXzexcX22NRTDL2Ja70f5X_g3FAg</recordid><startdate>19910201</startdate><enddate>19910201</enddate><creator>Sullivan, K L</creator><creator>Gardiner, Jr, G A</creator><creator>Kandarpa, K</creator><creator>Bonn, J</creator><creator>Shapiro, M J</creator><creator>Carabasi, R A</creator><creator>Smullens, S</creator><creator>Levin, D C</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19910201</creationdate><title>Efficacy of thrombolysis in infrainguinal bypass grafts</title><author>Sullivan, K L ; Gardiner, Jr, G A ; Kandarpa, K ; Bonn, J ; Shapiro, M J ; Carabasi, R A ; Smullens, S ; Levin, D C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-g229t-8774e39c5c89e331e68fc68aed66d2bafef8fb077e0dea442d5b647409e81303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1991</creationdate><topic>Aged</topic><topic>Blood Vessel Prosthesis</topic><topic>Female</topic><topic>Femoral Artery</topic><topic>Graft Occlusion, Vascular - drug therapy</topic><topic>Humans</topic><topic>Leg - blood supply</topic><topic>Life Tables</topic><topic>Male</topic><topic>Polytetrafluoroethylene</topic><topic>Popliteal Artery</topic><topic>Streptokinase - therapeutic use</topic><topic>Thrombolytic Therapy</topic><topic>Thrombosis - drug therapy</topic><topic>Urokinase-Type Plasminogen Activator - therapeutic use</topic><topic>Vascular Patency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sullivan, K L</creatorcontrib><creatorcontrib>Gardiner, Jr, G A</creatorcontrib><creatorcontrib>Kandarpa, K</creatorcontrib><creatorcontrib>Bonn, J</creatorcontrib><creatorcontrib>Shapiro, M J</creatorcontrib><creatorcontrib>Carabasi, R A</creatorcontrib><creatorcontrib>Smullens, S</creatorcontrib><creatorcontrib>Levin, D C</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sullivan, K L</au><au>Gardiner, Jr, G A</au><au>Kandarpa, K</au><au>Bonn, J</au><au>Shapiro, M J</au><au>Carabasi, R A</au><au>Smullens, S</au><au>Levin, D C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of thrombolysis in infrainguinal bypass grafts</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1991-02-01</date><risdate>1991</risdate><volume>83</volume><issue>2 Suppl</issue><spage>I99</spage><epage>105</epage><pages>I99-105</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>United States</cop><pmid>1991406</pmid></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 1991-02, Vol.83 (2 Suppl), p.I99-105 |
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| source | Free E-Journal (出版社公開部分のみ） |
| 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 |
| title | Efficacy of thrombolysis in infrainguinal bypass grafts |
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