Indications for directed thrombolysis or new bypass in treatment of occlusion of lower extremity arterial bypass reconstruction

The long-term results after directed thrombolytic therapy for thrombosis of infrainguinal arterial bypass reconstructions are disappointing if broad i ndications are applied. This work presents criteria for determining the ind ications for thrombolysis or the insertion of a new bypass. In a retrospect ive study we compared the secondary cumulative patency after bypass thrombo lysis (n = 82) and after replacement bypass (n = 143). Using multivariate a nalysis, the influence of prognostic factors on secondary long-term patency was investigated. Our results showed that brief occlusions (less than or e qual to 3 days) in older bypasses (greater than or equal to 11 months) shou ld be treated by thrombolysis. In all other cases, efforts should be made t o replace the bypass with autologous vein. In the absence of autologous vei n, we found umbilical vein to be a suitable material for vessel replacement .