Reference : Thrombolysis of occluded infra-inguinal bypass grafts: is it worthwhile?
Scientific journals : Article
Human health sciences : Surgery
Thrombolysis of occluded infra-inguinal bypass grafts: is it worthwhile?
Bonhomme, Stéphanie [Centre Hospitalier Universitaire de Liège - CHU > > HOPISTALISATION - URGENCES >]
Trotteur, Geneviève mailto [Centre Hospitalier Universitaire de Liège - CHU > > Imagerie médicale >]
Van Damme, Hendrik mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie cardio-vasculaire >]
Defraigne, Jean [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie cardio-vasculaire >]
Acta Chirurgica Belgica
Acta Medica Belgica
Yes (verified by ORBi)
[en] Blood Vessel Prosthesis ; Femoral Artery ; Fibrinolytic Agents/administration & dosage ; Graft Occlusion, Vascular/drug therapy ; Humans ; Infusions, Intravenous ; Limb Salvage ; Thrombolytic Therapy ; Tibial Arteries ; Treatment Outcome ; Vascular Patency
[en] BACKGROUND: Thrombosis of an infra-inguinal bypass graft often results in a limb-threatening ischemia. There is no consensus on the optimal management strategy. AIM OF THE STUDY: To analyse safety and efficacy of catheter-guided intra-arterial thrombolysis to re-open thrombosed infra-inguinal bypass grafts and to identify factors that influence graft patency and limb salvage rate after thrombolytic procedures. METHODS: A continuous cohort-study of 106 thrombolytic procedures between 1993 to 2008. RESULTS: Despite a high initial success rate (76%), the mid-term results are less convincing, with a 58% re-occlusion rate at 45 months follow-up. Thrombosed vein grafts, old (2 weeks or more) occlusions, poor run-off and failure to identify or rectify an underlying causative stenosis are determinant for a poor long-term outcome of thrombolytic procedures. COMMENTS : The outcome results of author's experience are consistent with literature reports. Thrombolysis of occluded infra-inguinal bypass grafts should be limited to selective cases (recent occlusion, prosthetic or vein graft in place since 1 year or more, critical limb ischemia). Despite its obvious advantages, the long-term outcome of thrombolytic procedures is deceiving. The inherent risk of hemorrhagic complications should also be taken in account at the decision making of treatment strategy. The question whether, in general, catheter-guided selective intra-arterial thrombolysis offers a significant advantage over operative revascularisation (thrombectomy or new bypass) remains unanswered. A more selective approach seems to favour thrombolysis as most appropriate strategy in the management of recent (< 2 weeks) thromboses of grafts in place since at least 1 year.

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