Related Experiment Videos
Observations on the use of thrombolytic agents for thrombotic occlusion of infrainguinal vein grafts
M Belkin1, M C Donaldson, A D Whittemore
1Department of Surgery and Radiology, Brigham and Women's Hospital, Boston, MA 02115.
Insights
Thrombolysis and revision of blocked vein grafts offer short-term success but poor long-term patency. Early detection of failing vein grafts is crucial for better limb salvage outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Regenerative Medicine
Background:
- Vein graft failure is a significant clinical challenge.
- Thrombolysis shows promise for short-term vein graft patency but lacks established long-term data.
Purpose of the Study:
- To evaluate the long-term patency and limb salvage rates after successful thrombolysis and revision of thrombosed vein grafts.
Main Methods:
- Retrospective analysis of 22 thrombosed vein grafts in 21 patients.
- Utilized thrombolytic agents including urokinase, tissue plasminogen activator, and streptokinase.
- Assessed outcomes after additional procedures like angioplasty and graft revision.
Main Results:
- Life-table analysis showed 36.6% patency at 1 year and 22.9% at 3 years post-thrombolysis.
- Limb salvage rates were 66.9% at 1 year and 60.3% at 3 years, aided by secondary interventions.
- Initial graft patency averaged 19 months before failure.
Conclusions:
- Successful thrombolysis and revision of thrombosed vein grafts do not yield favorable long-term patency.
- Emphasizes the importance of early detection of failing vein grafts to improve outcomes and prevent thrombosis.
Abstract:
Vein graft failure remains a major challenge for the vascular surgeon. Thrombolysis of occluded vein grafts has shown promising short-term results in restoring vein graft patency, however, the long-term results are not established. This study examines the long-term patency and limb salvage after successful thrombolysis and revision of 22 thrombosed vein grafts in 21 patients. There were 17 men and four women with an average age of 60 years (38 to 77 years). Failed vein grafts had an average primary patency of 19 months (1 to 84 months) and included eight in situ grafts and 14 non-in situ grafts. Twelve grafts were to the popliteal level, whereas 10 were infrapopliteal. Thrombolytic agents used included urokinase (15), tissue plasminogen activator (5), and streptokinase (2). After successful thrombolysis, 19 grafts underwent 26 additional procedures including percutaneous transluminal angioplasty (9), vein patch angioplasty (4), vein interposition or jump extension graft (9), or other procedures (4). Three patients had no additional procedure, but one was placed on sodium warfarin (Coumadin). After successful initial vein graft salvage, life-table analysis revealed a 36.6% +/- 11.9% patency at 1 year and a 22.9% +/- 11.6% patency at 3 years. After secondary failure six patients had further interventions contributing to an improved limb salvage of 66.9% +/- 11.6% at 1 year and 60.3% +/- 19.0% at 3 years. The results suggest that thrombosed vein grafts initially salvaged with thrombolysis and revision do not have a favorable long-term patency, and that a premium must be placed on the detection of the failing vein graft before thrombosis.