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Published on: January 18, 2018
The role of thrombolysis in acute infrainguinal bypass occlusion: a prospective nonrandomized controlled study
Joyce Tiek1, Inge Fourneau, Kim Daenens
1Department of Vascular Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
Insights
Intra-arterial thrombolysis for acute infrainguinal bypass occlusion can improve outflow vessels, but may require additional surgery. A strategy of thrombolysis followed by bypass grafting may enhance outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Acute infrainguinal bypass occlusion requires prompt treatment, typically surgical revascularization or intra-arterial thrombolysis.
- Improving the number of patent outflow vessels is crucial for long-term bypass patency.
Purpose of the Study:
- To compare the efficacy of thrombolysis versus primary surgical revascularization for acute infrainguinal bypass occlusion.
- To evaluate the impact of thrombolysis on the number of patent outflow vessels.
Main Methods:
- A prospective nonrandomized study included 54 patients with 56 occluded bypasses (February 2002 - August 2003).
- Thirty bypasses underwent thrombolysis; 26 underwent primary surgery.
- Outcomes including success rates, need for adjunctive surgery, and amputation-free survival were assessed.
Main Results:
- Thrombolysis success rate was 80%, with a doubling of patent outflow vessels. Surgical success rate was 85.71%.
- Adjunctive major surgery was required in 40% of successful thrombolysis cases.
- One-year amputation-free survival was 82.6% after thrombolysis and 87.5% after surgery. However, it was only 39.7% after thrombolysis without adjunctive major surgery.
Conclusions:
- Thrombolysis effectively restores bypass patency and improves outflow vessels.
- A combined strategy of initial thrombolysis to enhance outflow, followed by bypass grafting, may be a beneficial approach for acute infrainguinal bypass occlusion.
Abstract:
Current treatment of acute infrainguinal bypass occlusion consists of either surgical revascularization or catheter-guided intra-arterial thrombolysis with adjunctive correction of the underlying flow-limiting lesion. In maintaining long-term patency, improving the number of outflow vessels could be of utmost importance. To compare the efficiency of both thrombolysis and primary surgical revascularization and to study the effect of thrombolysis on the number of patent outflow vessels, a prospective nonrandomized study was performed. Between February 2002 and August 2003, 54 patients with 56 occluded bypasses were included. Thirty bypasses were treated with thrombolysis, 26 primarily with surgery. Thrombolysis was successful in 80% of cases, with restoration of patency of the bypass but also with doubling of the amount of patent outflow vessels; surgery was successful in 85.71% of cases. However, in only 60% of the successfully lysed bypasses no adjunctive major surgery was needed. Amputation-free survival was 87.5% 1 year after surgery and 82.6% 1 year after thrombolysis. One year after thrombolysis without adjunctive major surgery, the amputation-free survival was only 39.7%. Therefore, a strategy could be to start with thrombolysis to improve outflow followed by a new bypass, whatever the underlying causative lesions are.
