Thrombolysis combined with angioplasty for failed femorodistal arterial grafts.

This study examines the long-term clinical success and complications of thrombolysis-angioplasty (TLA) of failed arterial grafts performed in 17 patients (group 1) and matched with 21 patients (groups 2) who had intra-arterial thrombolysis (IAT) followed by graft revision. TLA consists of alternating thrombolysis with percutaneous transluminal angioplasty (PTA) in the treatment of occlusive arterial disease. Failed grafts consisted of 21 vein grafts, 6 ovine collagen grafts, 6 polytetrafluorethylene (PTFE) prostheses, 3 human umbilical veins and 2 polyurethane vascular grafts. All bypasses were below the knee, of which 13 were to the tibial level. Thrombolytic agents used were urokinase in 21 cases, tissue plasminogen activator in 13 cases and streptokinase in 4 cases. Following successful thrombolysis, PTA was performed with a 3 mm to 5 mm balloon catheters. Nine tandem lesions were corrected. In all 24 stenoses were treated: 14 anastomotic stenoses, 4 graft strictures and 5 peripheral stenotic lesions. The combined cumulative patency rate of both groups was 36% (SE 10.8%) at 3 years. The initial technical success rate in group 1 was 70% (12 of 17 grafts). The cumulative patency rate, as revealed by life-table analysis, was 35.6% (SE 10.2%) at one year and 21.3% (SE 9.6%) at 2 years. In all, 10 grafts failed at follow-up and in 6 of these cases secondary intervention was unsuccessful. Mid-graft and isolated lesions responded better than did anastomotic and tandem lesions. In group 2 the cumulative patency rate was 60.4% (SE 5.7%) at one year and 50.3% (SE 12.9%) at 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)