Salvage of occluded arterial bypass grafts by means of thrombolysis.

Seventy-two thrombosed peripheral arterial bypass grafts in 62 patients were treated by local intraarterial thrombolytic infusion. The initial success rate was 69% (50 of 72 grafts). Graft material and location had no significant effect on the initial results. Urokinase was used in 43 cases with a 84% success rate, and streptokinase was used in 29 cases with a 48% success rate. After a follow-up period that ranged from 2 to 58 months, 27 grafts remained patent, with an average patency duration of 15 months (median 8 months). Overall graft patency at the end of 1 year was 60% applying life-table analysis. Factors that were evaluated to determine their effect on long-term patency included graft age and material, graft location, and the presence or absence of an underlying correctable lesion. The most significant factor in long-term patency was the presence of a lesion that was correctable by surgical revision or balloon angioplasty. In 25 grafts with underlying stenotic lesions, the 1-year patency was 86% after successful treatment. Twenty-five grafts without detectable lesions had 37% 1-year patency.