IS THROMBOLYSIS OF OCCLUDED POPLITEAL AND TIBIAL BYPASS GRAFTS WORTHWHILE

Purpose: We analyzed the short- and long-term results for patients und ergoing thrombolysis of occluded infrainguinal bypass grafts at our in stitution over a 62-month period. Methods: Thirty-one patients with 40 episodes of graft thrombosis in 33 grafts managed by thrombolysis wer e retrospectively reviewed. The effects of graft age, material, and an atomy, symptoms, treatment, anticoagulation, and occlusion duration we re evaluated for impact on patency after thrombolysis. Dose and durati on of therapy with use of the technique of pulse-spray thrombolysis wa s assessed. Results: Thrombolysis successfully reestablished patency i n 92% of grafts treated. Mean lysis time and urokinase dose were 118 m inutes and 607,000 units, respectively. Responsible lesions were ident ified and treated by angioplasty or surgery in 35 of 37 cases. The pat ency rate after thrombolysis was 28% at 30 months, and the secondary p atency rate was 46% at is months. Duration of occlusion, symptoms, tre atment, graft anatomy, and prior graft revision did not impact on pate ncy. Mean secondary patency was 21.5 months in grafts in place over 1 year and 7.0 months in grafts in place for less than 1 year. Mean seco ndary patency was 23.8 months in polytetrafluoroethylene grafts and 8. 4 months in vein grafts. The limb salvage rate was 84% at 30 months, a nd the patient survival rate was 84% at 42 months. Conclusions: Pulse- spray thrombolysis is effective in rapidly recanalizing thrombosed inf rainguinal grafts. Grafts failing in the first year after placement sh ould generally be replaced, reserving thrombolysis and revision for gr afts greater than 1 year old. Vein grafts tolerate thrombosis less wel l than synthetic conduits and have decreased long-term patency.