LOCAL THROMBOLYSIS FOR OCCLUDED ARTERIAL GRAFTS - IS THE YIELD WORTH THE EFFORT

This study reports the results and complications of local thrombolytic therapy of 50 recently occluded grafts. These occurred in 41 patients with acute severe but still reversible ischemia. The majority were in fra-inguinal synthetic grafts. Thrombolysis was induced with urokinase (n = 1), streptokinase (n = 11) or alteplase (n = 38) via an intra-ar terial catheter. Complete angiographical lysis was obtained in 36 graf ts (72%) and partial lysis in 6 (12%). The highest lysis rate was obta ined with alteplase (32/36; 89%). Complementary endovascular and/or su rgical intervention was needed in 17 patients to correct an underlying stenosis and/or to save the limb. Fifteen complications occurred (30% ) of which distal embolization (n = 4) and bleeding (n = 8 of which 3 fatal) were the most frequent. Six of the bleeding episodes occurred i n patients on chronic aspirin intake. The late results were poor. At s ix months, the primary patency of successfully lysed grafts dropped to 19% and the limb salvage rate to 64%. Thrombolytic therapy is far fro m the ideal management of thrombosed grafts: maintenance of restored p atency is the challenge.