RT Journal
A1 Zuckerman DA, Alderman MG, Idso MC, Pilgram TK, Sicard GA
T1 Follow-up of infrainguinal graft thrombolysis: Analysis of predictors of clinical success
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD February 1
VO 138
IS 2
SP 198
OP 202
DO 10.1001/archsurg.138.2.198
UL http://dx.doi.org/10.1001/archsurg.138.2.198
AB Hypothesis 
    Thrombolysis is an accepted technique to salvage a failed infrainguinal bypass graft. Careful case selection, including consideration of the native arterial runoff and the type and location of the graft, will portend a better clinical outcome and prolonged graft patency.Design 
    Retrospective study of an inception cohort of 91 acutely thrombosed grafts.Setting 
    Academic tertiary care center.Patients 
    We analyzed 91 consecutive occluded grafts in 69 patients for secondary graft patency and clinical outcome.Intervention 
    Regional transcatheter thrombolysis.Main Outcome Measures 
    Technical success, secondary graft patency, and the need for major limb amputation.Results 
    Immediate technical success resulting in restoration of flow was achieved in 80 (88%) of 91 cases. Angioplasty or additional surgical intervention (eg, patch, interposition graft, or jump graft to a more distal site) was performed in 44 subjects (64%). Longer duration of secondary patency was associated with synthetic vs vein grafts (P = .03), popliteal vs distal (tibial/pedal) insertion of the anastomosis (P = .008), and intact native arterial outflow (P = .003). Twenty-three cases required major limb amputation in the follow-up period, but 17 (74%) of these had reocclusion within 30 days of thrombolysis. Only 43 grafts (47%) were found to be patent at 1-year follow-up.Conclusions 
    In carefully selected cases, thrombolytic therapy is an effective means to restore limb viability in patients with occluded infrainguinal grafts. Long-term patency rates, although similar to those of surgical series, remain poor.