title: A retrospective study examining thrombolysis for occluded femoro-popliteal grafts - is it worthwhile?
abstract: OBJECTIVE
  To assess the effectiveness of catheter directed thrombolysis (CDT) in the treatment of acute graft occlusion.
  
  
  METHODS
  Tissue prothrombin activator (rt-PA) was the sole agent used for thrombolysis. This was infused through a 4F straight 65 cm catheter placed under ultrasound guidance. Following a pre-CDT angiogram, a catheter was placed just proximal to the distal anastomosis. An infusion of rt-PA was given over 24 h. An assessment of acute clinical success, limb salvage rates, patency rates and complication rates were made over a period of one year.
  
  
  RESULTS
  80% (20/25) of grafts were successfully reopened immediately. 4/5 (80%) of the unsuccessful CDT cases required amputation within a few weeks. 60% (12/20) of successful CDT cases had an underlying stenotic lesion which required angioplasty. Limb salvage rate was 72% (18/25) at 12 months. There was no CDT related mortality. Secondary patency rate at 9 months was 76% (13/17).
  
  
  CONCLUSIONS
  CDT can achieve reasonable results in this group of challenging patients and may be seen as a useful accessory in the vascular toolkit. However, precise indications for its use need further clarification.
authors.affiliation: Department of Surgery, St Helier Hospital, Surrey, UK.
authors.forename: C U
authors.initials: CU
authors.lastname: Abraham-Igwe
authors.forename: M R S
authors.initials: MR
authors.lastname: Siddiqui
authors.forename: L T
authors.initials: LT
authors.lastname: Geddes
authors.forename: J
authors.initials: J
authors.lastname: Halls
authors.forename: A
authors.initials: A
authors.lastname: Irvine
authors.forename: N
authors.initials: N
authors.lastname: Browning
mesh_terms: D000368:Aged; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006083:Graft Occlusion, Vascular / Q000188:drug therapy*; D006801:Humans; D023821:Limb Salvage / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D058017:Vascular Grafting
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator