Direct graft puncture with use of a crossed catheter technique for thrombolysis of peripheral bypass grafts.
OBJECTIVE
To determine the efficacy and safety of direct graft puncture of peripheral arterial bypass grafts with placement of retrograde and antegrade catheters within the graft for thrombolytic therapy. This study also evaluated potential clinical benefit to patients.


METHODS
A retrospective study was performed on 19 patients with 24 peripheral bypass grafts and lower extremity ischemia of less than 1 month duration. Thrombolysis was performed with a continuous high-dose infusion of urokinase. Successful lysis was defined as greater than 95% clot dissolution with antegrade flow within the graft.


RESULTS
Technical success was achieved in 17 of 19 patients (89%). The complexity of operative intervention was diminished in 12 of 19 patients (63%). The major complication rate (16%) was significantly higher and, therefore, this technique has a role for patients in whom traditional access is not optimal, such as in those in whom access cannot be achieved or in those with long bypass grafts.


CONCLUSIONS
Direct graft puncture with placement of catheters across the proximal and distal anastomoses of bypass grafts is a safe method of access, with a major complication rate similar to conventional access techniques. This mode of graft access demonstrates efficacious thrombolysis and acts as a conduit for ancillary procedures.
Lee
D E
DE
Department of Radiology, University of Rochester Medical Center, NY 14642, USA. lee@rad.rochester.edu
Waldman
D L
DL
Sumida
R K
RK
Green
R M
RM
D000368:Aged; D000714:Anastomosis, Surgical; D002406:Catheterization, Peripheral; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy*; D011677:Punctures; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D014568:Urokinase-Type Plasminogen Activator