Thrombolysis of occluded femoropopliteal grafts

In a series of 44 occluded femoropopliteal grafts, streptokinase was used for thrombolytic therapy in 22 cases and urokinase in 22 cases. In most cases, thrombolytic agents were administered via an indwelling arterial catheter directly into the proximal thrombus. The catheter tip was advanced as thrombolysis occurred. Compared with streptokinase infusions, urokinase bolus injection followed by infusion had better results (77% vs 41%) and fewer complications (23% vs 50%). During thrombolytic infusion, concomitant heparin infusion was usually used to reduce the frequency of thrombus formation on the infusion catheter or recurrent thrombosis of the graft, once the tip of the infusion catheter was advanced distally. Follow-up in 23 of 26 successful cases showed that 11 of the grafts remained open at an average follow-up of 12 months or until the patient died. The 12 grafts that reoccluded remained open an average of 3 months. In none of the 18 failures was simple surgical thrombectomy or thrombectomy with graft revision effective in revascularizing the distal limb. The advantages of thrombolysis compared with thrombectomy are less trauma to the graft, which is especially important in vein grafts, and improved distal runoff due to lysis of infrapopliteal thrombus. Even among cases considered failures in this series, the surgical approach was often simplified because of partial thrombolysis. Thrombolysis requires a considerable amount of time, effort, and expense, but in certain patients where thrombectomy is indicated for the treatment of occluded femoropopliteal grafts this technique offers important advantages.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				W. F. Baker Jr Thrombolytic Therapy Clinical and Applied Thrombosis/Hemostasis, October 1, 2002; 8(4): 291 - 314. [PDF]

				R. K Greenberg and K. Ouriel A multi-modal approach to the management of bypass graft failure Vascular Medicine, August 1, 1998; 3(3): 215 - 220. [Abstract] [PDF]

				J. I. Weitz, J. Byrne, G. P. Clagett, M. E. Farkouh, J. M. Porter, D. L. Sackett, D. E. Strandness, and L. M. Taylor Diagnosis and Treatment of Chronic Arterial Insufficiency of the Lower Extremities: A Critical Review Circulation, December 1, 1996; 94(11): 3026 - 3049. [Full Text]

				C. W. Wyble, V. D. Karabinis, and M. D. Kerstein Intracranial Hemorrhage as the Synergistic Effect of Urokinase and Renal Dysfunction--A Case Report Vascular and Endovascular Surgery, June 1, 1993; 27(5): 395 - 399. [Abstract] [PDF]

				R. G. Sheiman and D. A. Phillips Combined Effects of Urokinase and Heparin on PTT Values During Thrombolytic Therapy Angiology, February 1, 1993; 44(2): 114 - 122. [Abstract] [PDF]

				S. Sprayregen, C. W. Bakal, and J. Cynamon Compression of Vein Graft by Hematoma During Fibrinolytic Therapy Simulating Intrinsic Venous Stricture--A Case Report Angiology, January 1, 1993; 44(1): 81 - 84. [Abstract] [PDF]

				I. D. Weisman, W. R. Stanchfield JR, C. A. Herzog, A. L. Ney, and D. P. Blake Left Ventricular Thromboembolic Occlusion of the Popliteal Artery Treated Nonoperatively with Local Urokinase Infusion A Case Report Angiology, February 1, 1988; 39(2): 179 - 186. [Abstract] [PDF]