Regional Thrombolytic Therapy and Stent Implantation in an Acutely Occluded Aortobifemoral Bypass Graft

Abstract

Purpose:

To present a case highlighting the efficacy of local thrombolysis followed by stent implantation in acute occlusion of an aortobifemoral bypass graft.

Case Report:

A 47-year-old man was referred to our catheterization laboratory for acute bilateral limb ischemia occurring 18 hours after an aortobifemoral bypass procedure. Angiography documented total occlusion due to massive thrombosis of the grafts. After 24 hours of local thrombolysis, repeat angiography showed complete lysis of the thrombus and an intimal flap in the abdominal aorta. A Palmaz stent was successfully implanted to cover the flap and restore adequate flow. At 1 year, the patient remains asymptomatic, and angiography showed patency of both the stent and the grafts.

Conclusions:

Based on this patient's response, local thrombolysis followed by stenting may be a safe and effective alternative to reoperation for the treatment of acute graft thrombosis caused by an intimal aortic flap. More experience with this approach is necessary to determine if this is an acceptable and effective mode of treatment.

Keywords

aortobifemoral graft graft failure graft thrombosis intimal flap thrombolysis recombinant tissue plasminogen activator Palmaz stent

Get full access to this article

View all access options for this article.

References

Brewster

. Clinical and anatomical consideration for surgery in aortoiliac disease and results of surgical treatment. Circulation. 1991;83:I42–52.

Complications of abdominal aortic surgery. In: Bernhard

Towne

, eds. Complications in Vascular Surgery, 2d ed. Orlando, FL: Grune & Stratton, Inc.; 1985:25–36.

Brewster

. Complications of aortic and lower extremity procedures. In: Strandness

van Breda

, eds. Vascular Diseases: Surgical and interventional Therapy. New York: Churchill Livingstone; 1994:1151–1177.

Brewster

. Re-operation for aortofemoral graft limb occlusion. In: Veith

, ed. Critical Problems in Vascular Surgery. St Louis: Quality Medical Publishing; 1989:341–351.

Brewster

Cooke

. Longevity of aortofemoral bypass grafts. In: Yao

JST

Pearce

, eds. Long-term Results in Vascular Surgery. Norwalk, CT: Appleton-Lange; 1993:149–161.

Ameli

Provan

Williamson

. Etiology and management of aorto-femoral bypass graft failure. J Cardiovasc Surg. 1987;28:695–700.

Kashyap

Quiñones-Baldrich

. Principles of thrombolytic therapy. In: Rutherford

, ed. Vascular Surgery, 5th ed. Philadelphia: WB Saunders; 2000:457–475.

Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity: The STILE trial. Ann Surg. 1994;220:251–268.

Ouriel

Veith

Sasahara

. Thrombolysis or peripheral arterial surgery: phase I results. TOPAS Investigators. J Vasc Surg. 1996;23:64–73.

10.

Ouriel

Veith

Sasahara

. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med. 1998;338:1105–1111.

11.

Sullivan

Gardiner

Jr Kandarpa

. Efficacy of thrombolysis in infrainguinal bypass grafts. Circulation. 1991;83(2 suppl):I99–105.

12.

Ries

Singer

Hofbeck

. Thrombolysis of a modified Blalock-Taussig shunt with recombinant tissue plasminogen activator in a newborn infant with pulmonary atresia and ventricular septal defect. Br Heart J. 1994;72:201–202.

13.

Malm

Holmqvist

Olsson

. Successful thrombolysis of a modified Blalock-Taussig shunt three days after operation. Ann Thorac Surg. 1998;65:1453–1455.

14.

Marty-Ane

Alric

Prudhomme

. Intravascular stenting of traumatic abdominal aortic dissection. J Vasc Surg. 1996;23:156–161.

15.

Chahid

Miguel

Mofid

. Treatment with aortic-iliac stents of acute lower limb ischemia in a patient complicating acute type B aortic dissection [in French]. J Radiol. 2001;82:506–509.