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Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
A multi-modal approach to the management of bypass graft failure
1The Center for Vascular Disease, The University of Rochester, NY 14642, USA.
Insights
Bypass graft failure in peripheral arterial occlusion can be treated with thrombolysis, a technique using plasminogen activators. This approach, combined with surgery or endovascular methods, is safe and effective for acute graft occlusion within two weeks.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Thrombosis Management
Background:
- Bypass graft failure remains a significant challenge in treating peripheral arterial occlusion.
- Current treatments often fall short in restoring graft patency effectively.
Purpose of the Study:
- To evaluate the efficacy of thrombolysis in managing failed bypass grafts.
- To assess the combined approach of thrombolysis, endovascular, and open surgery for acute graft occlusion.
Main Methods:
- Instillation of plasminogen activators directly into the thrombus of failed bypass grafts.
- Utilizing thrombolysis to restore graft patency and identify causative lesions.
- Employing open surgery or endovascular techniques to address identified lesions.
Main Results:
- Thrombolytic techniques successfully restore bypass grafts to their pre-occlusive state.
- This strategy effectively clears thrombus and unmasks lesions causing occlusion.
- Randomized trials confirm the safety and efficacy of thrombolysis for acute graft occlusion (within 2 weeks).
Conclusions:
- A combined treatment strategy including thrombolysis, endovascular procedures, and open surgery improves outcomes for acutely occluded bypass grafts.
- This integrated approach offers a superior alternative to immediate operation alone for acute graft failure.
Abstract:
Bypass graft failure is an unsolved problem in the contemporary treatment of peripheral arterial occlusion. Thrombolysis of a failed bypass graft is performed with instillation of plasminogen activators directly into the substance of the thrombus. Thrombolytic techniques can restore the bypass graft to its pre-occlusive state, clearing the inflow and outflow tracts of propagated thrombus and unmasking the causative lesion responsible for graft occlusion. Open surgery, or an endovascular modality, can then be employed to directly address these lesions. Recent randomized trials have demonstrated the safety and efficacy of a thrombolytic treatment strategy when the graft occlusion is acute, that is, when the patient presents within 2 weeks of the event. The appropriate management of the patient with an acutely occluded bypass graft includes thrombolysis, endovascular modalities and open surgery, employed in conjunction, to improve patient outcome over that observed with an immediate operation alone.
