THROMBOLYSIS FOR OCCLUDED VEIN BYPASS GRAFTS THROUGH SURGICAL ACCESS

Purpose: This report describes surgical access to occluded vein grafts for thrombolysis by direct cutdown where indirect angiographic techni ques have failed. Method: A sheath is introduced directly into the pro ximal vein graft. Distal thrombus is lysed following standard protocol . The residual thrombus at the origin of the graft is removed surgical ly, and the area is closed with a patch angioplasty. Results: Distal t hrombus was completely lysed in two vein grafts without bleeding compl ications. Conslusion: The thrombus ''cork'' that forms at the upper en d of an occluded vein graft may deflect the angiographer's guide wire, but the distal thrombus usually remains soft and amenable to lysis. A ngiographic access should not be a Limiting factor in thrombolysis of an occluded vein graft.