Direct graft puncture with use of a crossed catheter technique for thrombolysis of peripheral bypass grafts

PURPOSE: To determine the efficacy and safety of direct graft puncture of p eripheral arterial bypass grafts with placement of retrograde and antegrade catheters within the graft for thrombolytic therapy. This study also evalu ated potential clinical benefit to patients. MATERIALS AND METHODS: A retrospective study was performed on 19 patients w ith 24 peripheral bypass grafts and lower extremity ischemia of less than 1 month duration. Thrombolysis was performed with a continuous high-dose inf usion of urokinase, Successful lysis was defined as greater than 95% clot d issolution with antegrade flow within the graft, RESULTS: Technical success was achieved in 17 of 19 patients (89%), The com plexity of operative intervention was diminished in 12 of 19 patients (63%) . The major complication rate (16%) was significantly higher and, therefore , this technique has a role for patients in whom traditional access is not optimal, such as in those in whom access cannot be achieved or in those wit h long bypass grafts. CONCLUSION: Direct graft puncture with placement of catheters across the pr oximal and distal anastomoses of bypass grafts is a safe method of access, with a major complication rate similar to conventional access techniques. T his mode of graft access demonstrates efficacious thrombolysis and acts as a conduit for ancillary procedures.