title: Thrombolytic therapy of synthetic graft occlusions before vascular reconstructive procedures.
abstract: The objective of this study was to evaluate the impact of thrombolysis of synthetic grafts before urgent vascular reconstruction. In 29 patients, 41 thrombosed synthetic grafts that underwent intraarterial thrombolysis were studied. The cases were divided into three groups: group I--complete thrombolysis followed by reconstruction; group II--complete thrombolysis alone; and group III--incomplete lysis requiring reconstruction or sympathectomy. Follow-up ranged from 1 to 556 days (mean: 149 days). Kaplan-Meier analysis was used to determine patency and limb salvage rates. One-year patency and limb salvage rates were 53% and 95%, 34% and 67%, and 38% and 48%, respectively, for groups I, II, and III. Eighteen complications occurred in 16 of the 41 (39%) episodes. One patient died of intracranial hemorrhage. The best results were achieved when complete lysis was followed by appropriate reconstruction. Patency was equally poor in complete thrombolysis alone and reconstructions required by incomplete thrombolysis. Limb salvage was better after complete thrombolysis, regardless of the appropriate reconstruction.
authors.affiliation: Department of Surgery, Hahnemann University School of Medicine, Philadelphia, Pennsylvania 19102-1192.
authors.forename: T E
authors.initials: TE
authors.lastname: Arnold
authors.forename: T
authors.initials: T
authors.lastname: Maekawa
authors.forename: T
authors.initials: T
authors.lastname: Onohara
authors.forename: C
authors.initials: C
authors.lastname: Sano
authors.forename: R
authors.initials: R
authors.lastname: Kumashiro
authors.forename: J
authors.initials: J
authors.lastname: Sariego
authors.forename: P A
authors.initials: PA
authors.lastname: Khoury
authors.forename: A R
authors.initials: AR
authors.lastname: Wilson
authors.forename: M D
authors.initials: MD
authors.lastname: Kerstein
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014654:Vascular Patency
chemical_list: D014568:Urokinase-Type Plasminogen Activator