Low-dose intra-arterial thrombolysis in the treatment of occluded vascular grafts.

As the use of intra-arterial thrombolysis increases, its application to specific areas requires definition. The results of treatment of occluded vascular grafts are presented. Thrombolysis using streptokinase or tissue plasminogen activator was planned in the treatment of 18 occluded vascular grafts (five aortofemoral bifurcation grafts and 13 infrainguinal grafts). Two patients, both with infrainguinal occlusions, did not receive thrombolytic therapy and were considered failures of treatment. Successful lysis occurred in three of five aortofemoral grafts, in both infrainguinal vein grafts and in five of nine infrainguinal synthetic grafts. The overall success rate was approximately 60 per cent. Two-thirds of the patients required no intervention following successful lysis. Percutaneous transluminal angioplasty was not found to be a useful additional procedure. A review of the literature revealed that intra-arterial thrombolysis is significantly more successful in the treatment of suprainguinal graft occlusion than in infrainguinal occlusions, there being no difference between infrainguinal vein and synthetic grafts. Provided that the limb is viable and there are no contraindications, intra-arterial thrombolysis is a useful means of clearing occluded grafts.