Purpose: To evaluate the efficacy and outcome of
thrombolysis and thrombectomy for thrombosed polytetrafluoroethylene
stent-grafts inserted in the superficial femoral artery (SFA) for occlusive
disease.
Methods: A retrospective review was conducted of 79
consecutive patients with a thrombosed SFA endograft between November 2001 and
December 2011. Of these, 46 (58%) were treated with thrombolysis
(n=40, 87%) or thrombectomy (n=6, 13%) and form the
study group (33 men; median age 66.8 years, range 30–80). Median time
from stent-graft insertion to thrombosis was 3 months (range 0–53).
Results: Thrombolysis was successful in 38
(95%) patients over a mean 24 hours (range 3–48); one patient had
failed lysis and another died during lytic treatment. Thrombectomy was
successful in all 6 patients. Thrombosis without a causal lesion was
significantly more common in occlusions that presented <30 days after
insertion (p=0.01). Over a median follow-up of 14 months (range
1–69), reinterventions were performed for restenosis in 12 patients and
reocclusion in 14 patients, all within 18 months after thrombolytic treatment.
More than a third of patients (16/45) had definitive failures (2/6 from the
thrombectomy group); 4 were treated conservatively (no/minor symptoms) and 12
had bypass grafts. Three (7%) patients eventually required a major
amputation. The primary, assisted primary, and secondary patency rates of
thrombolysis at 6 months were 56%, 56%, and 68%,
respectively. Secondary patency for the entire cohort was 58% at 1
year.
Conclusion: Thrombolysis and thrombectomy of
thrombosed endografts in the SFA is effective and safe. Patency rates after
treatment are moderate, but prolonged secondary patency can be achieved.
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