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  • Title: Follow-up of infrainguinal graft thrombolysis: analysis of predictors of clinical success.
    Author: Zuckerman DA, Alderman MG, Idso MC, Pilgram TK, Sicard GA.
    Journal: Arch Surg; 2003 Feb; 138(2):198-202. PubMed ID: 12578420.
    Abstract:
    HYPOTHESIS: Thrombolysis is an accepted technique to salvage a failed infrainguinal bypass graft. Careful case selection, including consideration of the native arterial runoff and the type and location of the graft, will portend a better clinical outcome and prolonged graft patency. DESIGN: Retrospective study of an inception cohort of 91 acutely thrombosed grafts. SETTING: Academic tertiary care center. PATIENTS: We analyzed 91 consecutive occluded grafts in 69 patients for secondary graft patency and clinical outcome. INTERVENTION: Regional transcatheter thrombolysis. MAIN OUTCOME MEASURES: Technical success, secondary graft patency, and the need for major limb amputation. RESULTS: Immediate technical success resulting in restoration of flow was achieved in 80 (88%) of 91 cases. Angioplasty or additional surgical intervention (eg, patch, interposition graft, or jump graft to a more distal site) was performed in 44 subjects (64%). Longer duration of secondary patency was associated with synthetic vs vein grafts (P =.03), popliteal vs distal (tibial/pedal) insertion of the anastomosis (P =.008), and intact native arterial outflow (P =.003). Twenty-three cases required major limb amputation in the follow-up period, but 17 (74%) of these had reocclusion within 30 days of thrombolysis. Only 43 grafts (47%) were found to be patent at 1-year follow-up. CONCLUSIONS: In carefully selected cases, thrombolytic therapy is an effective means to restore limb viability in patients with occluded infrainguinal grafts. Long-term patency rates, although similar to those of surgical series, remain poor.
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