THROMBOLYSIS OF OCCLUDED INFRAINGUINAL VEIN GRAFTS - PREDICTORS OF OUTCOME

Purpose: The purpose of this study was to identify factors that influe nce graft patency and limb salvage rates after thrombolysis of occlude d infrainguinal vein grafts. Methods: The records of patients who unde rwent percutaneous catheter-directed thrombolysis of occluded infraing uinal vein bypass grafts at our institution between 1985 and 1995 were reviewed. Life table analysis was used to determine survival and pate ncy differences. Univariate and multivariate analyses were used to ide ntify the patient-specific factors that affected outcomes. Results: Fo rty-four patients with 44 thrombosed infrainguinal vein grafts underwe nt thrombolysis with urokinase. The thrombolysis-related mortality rat e was 2%, and nonfatal complications occurred in 16%. Thrombolysis was unable to restore graft patency in 25% of grafts (11 of 44). Of the r emaining 33 successfully lysed grafts, 88% required adjunctive surgery or percutaneous transluminal angioplasty after thrombolysis. Overall, the primary graft patency rate was 25% at 1 pear and 19% at 2 years a fter thrombolysis. Considering only successfully lysed grafts, the pri mary patency rate improved to 34% at 1 year and 25% at 2 years. Multiv ariate analysis revealed that the graft patency rate was substantially better in patients without diabetes and in vein grafts that had been in place for longer than 12 months (p < 0.01). The limb salvage rate w as significantly improved by successful thrombolysis (63% at 2 years v s 31% if lysis failed; p < 0.01). The patient survival rate was high-8 9% 2 years after thrombolysis. Conclusions: Even with adjunctive thera py, vein graft thrombolysis is unlikely to yield durable patency overa ll. However, successful thrombolysis improves limb salvage rates and m ay be beneficial in patients without diabetes who have mature vein gra fts but who do not have options for other autogenous revascularization procedures.