Local thrombolysis in the treatment of arterial graft occlusions.
Nineteen patients with 20 occluded arterial bypass grafts were treated with local infusion of streptokinase. Grafts treated included four aortofemoral graft limbs, 14 femoropopliteal or femorotibial grafts, one axillofemoral graft, and one transpubic femorofemoral graft. Complete lysis of thrombus was possible in 12 patients, partial lysis in five patients, and no lysis in two patients. Thrombolytic therapy was thought to be beneficial in the management of 14 patients. In two of these 14 only thrombolysis was required to restore and maintain graft patency, and in an additional two patients angioplasty was performed after thrombolytic therapy with no subsequent therapy necessary. In three patients who were initially poor operative risks, surgery could be postponed. Thrombolysis revealed the probable cause of thrombosis in 12 patients. Complications included four bleeding episodes, two of which were significant. There were no significant embolic complications. Unsuccessful thrombolytic therapy did not result in worsening of ischemia in any patient. Local infusion of thrombolytic agents is a useful adjunct in the management of occluded bypass grafts.
D000328:Adult; D000368:Aged; D001011:Aorta; D005260:Female; D005263:Femoral Artery; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006083:Graft Occlusion, Vascular / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D013300:Streptokinase / Q000009:adverse effects / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D013300:Streptokinase