Long-term results of catheter-directed thrombolysis to treat infrainguinal bypass graft occlusion: the urokinase era.

Objective: This study was undertaken to review the long-term results of catheter-directed thrombolysis in treatment of infrainguinal bypass graft occlusion.

Methods: From January 1987 to December 1998, 67 patients with 69 acutely occluded infrainguinal arterial bypass grafts (48 vein grafts, 21 prosthetic grafts) underwent treatment with catheter-directed thrombolysis with urokinase. Long-term results were assessed with Kaplan-Meier life-table analysis, and factors predictive of success were determined with multivariate analysis.

Results: Thrombolysis was aborted in 7 patients (10%) because of major complications or technical failure and was unsuccessful in restoring graft patency (

Conclusions: Coupled with identification and aggressive treatment of underlying causative lesions, catheter-directed thrombolysis can salvage many thrombosed vein grafts, with expectation of long-term patency similar to that with repeat bypass grafting. Poor short-term results of thrombolysis of occluded prosthetic grafts support repeat operation with a completely new bypass graft as a more appropriate option.