title: Salvage of occluded arterial bypass grafts by means of thrombolysis.
abstract: 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.
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa. 19107.
authors.forename: G A
authors.initials: GA
authors.lastname: Gardiner
authors.forename: D P
authors.initials: DP
authors.lastname: Harrington
authors.forename: W
authors.initials: W
authors.lastname: Koltun
authors.forename: A
authors.initials: A
authors.lastname: Whittemore
authors.forename: J A
authors.initials: JA
authors.lastname: Mannick
authors.forename: D C
authors.initials: DC
authors.lastname: Levin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001807:Blood Vessel Prosthesis; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D013300:Streptokinase / Q000627:therapeutic use; D013927:Thrombosis / Q000188:drug therapy* / Q000628:therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator