title: Indications for directed thrombolysis or new bypass in treatment of occlusion of lower extremity arterial bypass reconstruction.
abstract: The long-term results after directed thrombolytic therapy for thrombosis of infrainguinal arterial bypass reconstructions are disappointing if broad indications are applied. This work presents criteria for determining the indications for thrombolysis or the insertion of a new bypass. In a retrospective study we compared the secondary cumulative patency after bypass thrombolysis (n = 82) and after replacement bypass (n = 143). Using multivariate analysis, the influence of prognostic factors on secondary long-term patency was investigated. Our results showed that brief occlusions (< or = 3 days) in older bypasses (> or = 11 months) should be treated by thrombolysis. In all other cases, efforts should be made to replace the bypass with autologous vein. In the absence of autologous vein, we found umbilical vein to be a suitable material for vessel replacement.
authors.affiliation: Elisabethinen Hospital Linz, Surgical Department, Fadingerstrasse 1, A-4010 Linz, Austria. th.schwierz@gmx.at
authors.forename: T
authors.initials: T
authors.lastname: Schwierz
authors.forename: M
authors.initials: M
authors.lastname: Gschwendtner
authors.forename: W
authors.initials: W
authors.lastname: Havlicek
authors.forename: F
authors.initials: F
authors.lastname: Schmoeller
authors.forename: H J
authors.initials: HJ
authors.lastname: Boehmig
authors.forename: R
authors.initials: R
authors.lastname: Függer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D001317:Austria; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency / Q000187:drug effects / Q000502:physiology; D014656:Vascular Surgical Procedures
chemical_list: D011138:Polytetrafluoroethylene; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator