Thrombolysis in arterial graft thrombosis.

OBJECTIVE

to assess the impact of peripheral arterial thrombolysis for vascular graft occlusion.

DESIGN

Retrospective review.

SETTING

University Hospital.

MATERIALS

Thirty-one patients presented with 33 episodes of graft thrombosis.

CHIEF OUTCOME MEASURES

Successful thrombolysis in terms of total clearance or sufficient clearance to reveal an underlying factor responsible for graft failure.

MAIN RESULTS

Thrombolysis was successful in seven of 10 suprainguinal grafts (4 of 5 rtPA; 3 of 5 SK). One patient had failed lysis requiring an ilio-femoral graft. Of the seven patients with successful lysis, one required revision of a proximal anastomosis, two required distal anastomotic revisions, and one rethrombosed. Twenty-three thrombosed infrainguinal grafts were managed initially with intraarterial thrombolysis (9rtPA, 14 SK). Of 27 patients surviving at 30 days, seven required major amputation despite aggressive intervention.

CONCLUSIONS

Thrombosed suprainguinal grafts are amenable to thrombolysis and adjunctive surgery when necessary, with no major haemorrhagic complications. The majority of patients with thrombosed infrainguinal grafts require surgical intervention in order to preserve, or establish long term patency. For polytetrafluoroethylene (PTFE) grafts, thrombolysis was associated with poor success, haemorrhagic complications and a high amputation rate.