[Interventional procedures in patients after vascular reconstructive surgery of the lower extremities]

This study reports the results and complications of local thrombolysis therapy of recently occluded grafts manifested by acute ischemia in comparison with transluminal angioplasty of graft stenoses. Stenoses were diagnosed by means of ultrasound (asymptomatic patients) or manifested by claudications. The aim of our study is to emphasize the difference between efficacy of these two kinds of treatment and their difficulties. Fourty three patients were treated in the period of 39 months (March 1994-June 1997). Sixty seven interventional procedures were done, including 32 local thrombolysis in 20 patients and 35 angioplasties in 23 patients. Types of grafts were: aortofemoral (n = 8), ilicofemoral (n = 4) and one aortotibioposterior, femoropopliteal vein (n = 18) and synthetic (n = 9) and two distal tibioposterior bypasses. Fourty one bypasses were created due to arteriosclerotic occlusion, one for traumatic amputation and one due to stenosis after perinatal catheterization. The period between surgery and intervention varied from 1 month to 11 years (mean 33 months), the mean follow up period was 13 months. Technical success rate in patients treated by local thrombolysis was 69% (n = 22). Midterm graft patency in the this group is 40% (n = 8) with 95% (n = 19) limb salvage. In patients treated by transluminal angioplasty was technical success rate 97% (n = 34). In this group is patent 96% (n = 20) bypasses with 31% (n = 4) restenoses. All patients with patent grafts have a good run-off with at least 2 patent calf arteries. Six complications occurred during local thrombolytic therapy. Our results indicate that despite of the high initial success rate are the late results poor in the group treated by thrombolysis because of the high rate of rethromboses. The result depends on number of patent calf arteries. Results in patients treated by angioplasty only are much better with lower risk of complications during procedure. Our results prove that it is better to follow patients after lower limb bypass surgery by ultrasonography and perform angioplasty when stenoses occur.