Thrombolysis of occluded infrainguinal vein grafts: predictors of outcome.
OBJECTIVE
The purpose of this study was to identify factors that influence graft patency and limb salvage rates after thrombolysis of occluded infrainguinal vein grafts.


METHODS
The records of patients who underwent percutaneous catheter-directed thrombolysis of occluded infrainguinal vein bypass grafts at our institution between 1985 and 1995 were reviewed. Life table analysis was used to determine survival and patency differences. Univariate and multivariate analyses were used to identify the patient-specific factors that affected outcomes.


RESULTS
Forty-four patients with 44 thrombosed infrainguinal vein grafts underwent thrombolysis with urokinase. The thrombolysis-related mortality rate was 2%, and nonfatal complications occurred in 16%. Thrombolysis was unable to restore graft patency in 25% of grafts (11 of 44). Of the remaining 33 successfully lysed grafts, 88% required adjunctive surgery or percutaneous transluminal angioplasty after thrombolysis. Overall, the primary graft patency rate was 25% at 1 year and 19% at 2 years after thrombolysis. Considering only successfully lysed grafts, the primary patency rate improved to 34% at 1 year and 25% at 2 years. Multivariate analysis revealed that the graft patency rate was substantially better in patients without diabetes and in vein grafts that had been in place for longer than 12 months (p < 0.01). The limb salvage rate was significantly improved by successful thrombolysis (63% at 2 years vs 31% if lysis failed; p < 0.01). The patient survival rate was high-89% 2 years after thrombolysis.


CONCLUSIONS
Even with adjunctive therapy, vein graft thrombolysis is unlikely to yield durable patency overall. However, successful thrombolysis improves limb salvage rates and may be beneficial in patients without diabetes who have mature vein grafts but who do not have options for other autogenous revascularization procedures.
Nackman
G B
GB
Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
Walsh
D B
DB
Fillinger
M F
MF
Zwolak
R M
RM
Bech
F R
FR
Bettmann
M A
MA
Cronenwett
J L
JL
D000368:Aged; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008297:Male; D010960:Plasminogen Activators / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D015996:Survival Rate; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014654:Vascular Patency; D014680:Veins / Q000601:surgery
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator