Local thrombolysis in the treatment of arterial graft occlusions

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Pharmacology

Background:

• Arterial bypass graft occlusion is a significant cause of limb ischemia.
• Thrombolytic therapy offers a less invasive approach to managing graft occlusion.

Purpose of the Study:

• To evaluate the efficacy and safety of local streptokinase infusion for occluded arterial bypass grafts.
• To assess the role of thrombolysis in restoring graft patency and its impact on patient management.

Main Methods:

• Nineteen patients with 20 occluded arterial bypass grafts received local streptokinase infusion.
• Graft types included aortofemoral, femoropopliteal/femorotibial, axillofemoral, and transpubic femorofemoral grafts.
• Outcomes assessed included thrombus lysis, graft patency, need for further intervention, and complications.

Main Results:

• Complete thrombus lysis was achieved in 12 patients, with partial lysis in five.
• Thrombolytic therapy was beneficial in 14 patients, restoring or maintaining graft patency.
• In some cases, thrombolysis alone or combined with angioplasty successfully managed occlusion, and surgery was postponed in others.
• Thrombolysis identified the cause of thrombosis in 12 patients.
• Four bleeding episodes occurred, two significant; no significant embolic complications were noted.
• Unsuccessful thrombolysis did not worsen ischemia.

Conclusions:

• Local streptokinase infusion is a useful adjunct for managing occluded arterial bypass grafts.
• Thrombolysis can restore graft patency, facilitate diagnosis, and potentially delay or avoid surgery.
• The procedure demonstrated an acceptable safety profile with manageable complications.