title: Outcome after catheter-directed thrombolysis of occluded prosthetic femoropopliteal bypasses. A prospective study.
abstract: OBJECTIVE
  To evaluate the outcome after catheter-directed thrombolysis of occluded femoropopliteal prosthetic bypasses with the distal anastomosis above the knee.
  
  
  METHODS
  Twenty-one patients were included in this prospective study. End-hole catheters, a bolus dose and continuous infusion of recombinant tissue-plasminogen activator (rt-PA) were used, with a median total dose of 10 mg (range 7-20 mg).
  
  
  RESULTS
  With an intra-thrombotic position of the catheter, total or subtotal lysis was obtained in 19 of 21 patients (90%). No serious complications occurred. In 9 patients, the stenoses were successfully treated with balloon angioplasty (PTA, n=5), local thrombectomy/extension of bypass (n=3), or with a new bypass (n=1). After a median observation time of 18 months (6-24), 5 patients had open bypass. Re-occlusion occurred in all (6/6) bypasses in which no flow-limiting lesion was discovered, in all (4/4) bypasses treated twice with thrombolysis, as well as in all bypasses in which stenoses had not been adequately treated (3/3). One bypass re-occluded immediately due to poor runoff.
  
  
  CONCLUSIONS
  In the present study, 19/21 infra-inguinal prosthetic bypasses were successfully treated with catheter-directed thrombolysis. However, re-occlusion often took place, especially in bypasses without flow-limiting lesions. If re-occlusion occurs in a bypass in which no stenoses were revealed during the primary thrombolysis procedure, a second catheter-directed thrombolytic treatment does not seem to be warranted. Our results confirm that treatment of flow-limiting lesions is a prerequisite for maintaining patency.
authors.affiliation: Department of Radiology, Aker Hospital, University of Oslo, Norway.
authors.forename: G
authors.initials: G
authors.lastname: Sandbaek
authors.forename: L E
authors.initials: LE
authors.lastname: Staxrud
authors.forename: L
authors.initials: L
authors.lastname: Rosén
authors.forename: C E
authors.initials: CE
authors.lastname: Slagsvold
authors.forename: P
authors.initials: P
authors.lastname: Stavis
authors.forename: D
authors.initials: D
authors.lastname: Bay
authors.forename: T
authors.initials: T
authors.lastname: Gjølberg
authors.forename: F
authors.initials: F
authors.lastname: Kolmannskog
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000800:Angioplasty, Balloon; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002406:Catheterization, Peripheral; D003251:Constriction, Pathologic / Q000628:therapy; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator