Outcome after catheter-directed thrombolysis of occluded prosthetic femoropopliteal bypasses. A prospective study.

PURPOSE: To evaluate the outcome after catheter-directed thrombolysis of occluded femoropopliteal prosthetic bypasses with the distal anastomosis above the knee.

MATERIAL AND

METHODS

Twenty-one patients were included in this prospective study. End-hole catheters, a bolus dose and continuous infusion of recombinant tissue-plasminogen activator (rt-PA) were used, with a median total dose of 10 mg (range 7-20 mg).

RESULTS

With an intra-thrombotic position of the catheter, total or subtotal lysis was obtained in 19 of 21 patients (90%). No serious complications occurred. In 9 patients, the stenoses were successfully treated with balloon angioplasty (PTA, n=5), local thrombectomy/extension of bypass (n=3), or with a new bypass (n=1). After a median observation time of 18 months (6-24), 5 patients had open bypass. Re-occlusion occurred in all (6/6) bypasses in which no flow-limiting lesion was discovered, in all (4/4) bypasses treated twice with thrombolysis, as well as in all bypasses in which stenoses had not been adequately treated (3/3). One bypass re-occluded immediately due to poor runoff.

CONCLUSION

In the present study, 19/21 infra-inguinal prosthetic bypasses were successfully treated with catheter-directed thrombolysis. However, re-occlusion often took place, especially in bypasses without flow-limiting lesions. If re-occlusion occurs in a bypass in which no stenoses were revealed during the primary thrombolysis procedure, a second catheter-directed thrombolytic treatment does not seem to be warranted. Our results confirm that treatment of flow-limiting lesions is a prerequisite for maintaining patency.