The performance of commercially available sealed Dacron vascular grafts in intraarterial thrombolytic therapy

The purpose of this study was to assess whether two commercially available, sealed arterial prostheses would tolerate catheter directed, intraarterial thrombolytic therapy. Sealed vascular grafts were implanted in 12 mongrel dogs for 3, 4, and 6 week intervals as iliac artery interposition grafts. This allowed direct comparison of two types of sealed grafts in the same animal. The indications for graft failure consisted of clinically evident bleeding, transluminal extravasation, or anastomotic leakage of contrast medium documented by angiography. Thrombolytic therapy (urokinase) was delivered immediately proximal to the grafts in the distal aorta, thereby exposing the intraluminal surfaces to urokinase delivered directly from the catheter tip, as well as to the accumulated systemic levels of urokinase and urokinase activated plasmin. There was no evidence of postoperative bleeding or extravasation of contrast medium during any follow-up arteriogram in any animal. There was no discernible extravasation of contrast medium noted at the anastomotic sites. At the time of explantation, no graft demonstrated any evidence of subclinical extravasation, such as separation of the external capsule from the abluminal surface of the graft. It is concluded that it appears safe to use thrombolytic therapy in these grafts as early as 3 weeks postimplantation.