Successful angioplasty of a chronically occluded saphenous vein graft using a prolonged urokinase infusion from the brachial route.
A 68-year-old man who presented with unstable angina had had cardiac bypass surgery 12 years earlier and successful angioplasty of a native circumflex lesion 18 months previously. Repeat catheterization showed a widely patent angioplasty site but interval closure of a saphenous vein graft to a large marginal branch that was totally occluded proximally. A stress test revealed significant myocardial ischemia. Severe peripheral peripheral vascular disease with known bilateral iliac artery occlusions mandated a brachial approach. Because of his high risk for repeat cardiac surgery, it was elected to attempt saphenous graft angioplasty following a prolonged urokinase infusion. After an infusion of urokinase for 36 hr, antegrade flow was restored and angioplasty was carried out successfully on a discrete mid-graft legion. Subsequent stress testing showed resolution of the ischemia. There were no vascular complications.
Doorey
A J
AJ
Department of Medicine, Medical Center of Delaware, Newark 19713.
Rosenbloom
M A
MA
Zolnick
M R
MR
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001916:Brachial Artery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D011859:Radiography; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
D014568:Urokinase-Type Plasminogen Activator