Thrombolysis of Occluded Synthetic Bypass Grafts in the Lower Limb: Technical Success and 1-Year Follow-up in 32 Patients

Abstract

Purpose:

To evaluate prospectively the technical success and clinical outcome of thrombolysis for acute occlusion of synthetic arterial bypass grafts in the lower limb.

Methods:

Thirty-two consecutive patients (27 men; median age 65 years, range 41–80) with occluded polytetrafluoroethylene bypass grafts were treated with direct-catheter thrombolysis (100,000-IU bolus of urokinase with 100,000-IU/h infusion) followed by ancillary interventions to treat underlying stenosis whenever necessary. All patients received oral anticoagulation to maintain the international normalized ratio at 3.0 to 4.0. Clinical follow-up and duplex ultrasound examinations were performed at 3-month intervals up to 1 year.

Results:

Thrombolysis was technically successful in 27 (84%) patients; 3 of the 5 failed patients had amputations. Mean duration of urokinase therapy was 36±14 hours. In 18 patients, underlying stenoses (11 distal anastomosis, 5 proximal anastomosis, and 3 inflow) were treated, 15 by an endovascular procedure and 3 surgically. Four major complications occurred: groin hematoma, sepsis, transient renal dysfunction, and a hemorrhage at the proximal anastomosis after urokinase treatment. At 1 year, 21 bypass grafts had reoccluded (20% patency rate on intention-to-treat basis); 3 reocclusions resulted in amputation (overall 19% amputation rate).

Conclusions:

Thrombolysis in the setting of acute lower limb bypass graft occlusion is associated with good initial technical success rates and satisfactory clinical results. However, the re-occlusion rate within 1 year is high.