EVALUATION OF MULTIPLE VASCULAR RECONSTRUCTIVE PROCEDURES WITH SYNTHETIC GRAFT OCCLUSIONS

The objective of this study was to evaluate the efficiency of multiple vascular reconstructive procedures in the presence of an occluded syn thetic graft. Over a four year period seventy-seven occluded synthetic grafts were treated with urokinase and reconstruction. Follow-up rang ed from 1 to 162-17 days (4 years, 5 1/2 months). Kaplan-Meier and gen eralized Wilcoxon test were used to determine patency and limb salvage rates. The cases were divided into three groups according to the numb er of previous reconstructive events. Group I consisted of patients th at had undergone one previous vascular reconstructive procedure. Group II consisted of patients that had undergone two previous vascular rec onstructive procedures. Group III consisted of patients who had underg one three or more previous reconstructive procedures. In Group I, the one, two, and three year patency rates were 48.6%, 34.7%, and 26.0% an d the limb salvage rates were 76.2 %, 67.9%, and 67.9% for one, two, a nd three years respectively. The Group II patency rates were 41.9%, 24 .4%, and 16.3% and the limb salvage rates were 73.7%, 66.3%, and 66.3% . The Group III patency rates were 31.8%, 5.5%, and 5.5% and the limb salvage rates were 76.6%, 54.8%, and 54.8%. The patency rate was signi ficantly reduced when Group Ill was compared to Group I (p < 0.01). Th ere was no statistically significant difference in limb salvage rates between any of the groups. These results indicate that the number of s econdary vascular reconstructive procedures combined with thrombolysis had no correlation with the prognosis of limb salvage. The high rate of limb salvage in this study appears to justify thrombolysis and mult iple secondary procedures regardless of the number of previous reconst ructions.