Thrombolysis therapy in patients with femoropopliteal synthetic graft occlusions

Background The aim of this study was to evaluate the efficiency of thrombolysis in the presence of an occluded femoropopliteal synthetic graft. Patients and methods Over a 3-year period, 46 occluded femoropopliteal grafts were treated with urokinase and reconstruction. The cases were divided into three groups: group 1 (n = 25), complete thrombolysis followed by reconstruction or angioplasty or both; group 2 (n = 5), complete thrombolysis alone; and group 3 (n = 16), failure of thrombolysis requiring reconstruction or leading to amputation. Patients were closely observed after the treatment for more than 1 year. Results There are no fatal complications among patients with thrombolytic therapy. In group 1, the 3-year patency rates were 12% and the 3-year limb salvage rates were 77%. In group 2, the 3-year patency rates and the limb salvage rates were 20% and 80%, respectively. The group 3 patency rates and the limb salvage rates were 8% and 40%, respectively. The best results were achieved in patients who had thrombolysis followed by reconstruction (group 1) and in those who had thrombolysis alone (group 2). Limb salvage was poor in patients with failure of lytic therapy regardless of the reconstruction (P< 0.01). Conclusion The use of intra-arterial urokinase followed by secondary vascular reconstructive procedures was studied. The patient with synthetic graft occlusion still has a reasonably favorable prognosis for long-term limb salvage when thrombolysis is successful.