Follow-up of infrainguinal graft thrombolysis: Analysis of predictors of clinical success

Hypothesis: Thrombolysis is an accepted technique to salvage a failed infrainguinal bypass graft. Careful case selection, including consideration of the native arterial runoff and the type and location of the graft, will portend a better clinical outcome and prolonged graft patency. Design: Retrospective study of an inception cohort of 91 acutely thrombosed grafts. Setting: Academic tertiary care center. Patients: We analyzed 91 consecutive occluded grafts in 69 patients for secondary graft patency and clinical outcome. Intervention: Regional transcatheter thrombolysis. Main Outcome Measures: Technical success, secondary graft patency, and the need for major limb amputation. Results: Immediate technical success resulting in restoration of flow was achieved in 80 (88%) of 91 cases. Angioplasty or additional surgical intervention (eg, patch, interposition graft, or jump graft to a more distal site) was performed in 44 subjects (64%). Longer duration of secondary patency was associated with synthetic vs vein grafts (P=.03), popliteal vs distal (tibial/pedal) insertion of the anastomosis (P=.008), and intact native arterial outflow (P=.003). Twenty-three cases required major limb amputation in the follow-up period, but 17 (74%) of these had reocclusion within 30 days of thrombolysis. Only 43 grafts (47%) were found to be patent at 1-year follow-up. Conclusions: In carefully selected cases, thrombolytic therapy is an effective means to restore limb viability in patients with occluded infrainguinal grafts. Long-term patency rates, although similar to those of surgical series, remain poor.