THROMBOLYSIS IN ARTERIAL GRAFT THROMBOSIS

Objective: to assess the impact of peripheral arterial thrombolysis for vascular graft occlusion. Design: Retrospective review. Setting: University Hospital. Materials: Thirty-one patients presented with 33 episodes of graft thrombosis. Chief outcome measures: Successful thrombolysis in terms of total clearance or sufficient clearance to reveal an underlying factor responsible for graft failure. Main results: Thrombolysis was successful in seven of 10 suprainguinal grafts (4 of 5 rtPA; 3 of 5 SK). One patient had Jailed lysis requiring an ilio-femoral graft. Of the seven patients with successful lysis, one required revision of a proximal anastomosis, two required distal anastomotic revisions, and one rethrombosed. Twenty-three thrombosed infrainguinal grafts were managed initially with intraarterial thrombolysis (9rtPA, 14 SK). Of 27 patients surviving at 30 days, seven required major amputation despite aggressive intervention. Conclusions: Thrombosed suprainguinal grafts are amenable to thrombolysis and adjunctive surgery when necessary, with no major haemorrhagic complications. The majority of patients with thrombosed infrainguinal grafts require surgical intervention in order to preserve, or establish long term patency. For polytetrafluorethylene (PTFE) grafts, thrombolysis was associated with poor success, haemorrhagic complications and a high amputation rate.