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Analysis of Predictors of Clinical Success

Darryl A. Zuckerman, MD; Mary G. Alderman, MD; Mary C. Idso, RN; Thomas K. Pilgram, PhD; Gregorio A. Sicard, MD

Arch Surg. 2003;138:198-202.

Hypothesis  Thrombolysis is an accepted technique to salvage a failed infrainguinal bypass graft. Careful case selection, including consideration of the native arterial runoff and the type and location of the graft, will portend a better clinical outcome and prolonged graft patency.

Design  Retrospective study of an inception cohort of 91 acutely thrombosed grafts.

Setting  Academic tertiary care center.

Patients  We analyzed 91 consecutive occluded grafts in 69 patients for secondary graft patency and clinical outcome.

Intervention  Regional transcatheter thrombolysis.

Main Outcome Measures  Technical success, secondary graft patency, and the need for major limb amputation.

Results  Immediate technical success resulting in restoration of flow was achieved in 80 (88%) of 91 cases. Angioplasty or additional surgical intervention (eg, patch, interposition graft, or jump graft to a more distal site) was performed in 44 subjects (64%). Longer duration of secondary patency was associated with synthetic vs vein grafts (P = .03), popliteal vs distal (tibial/pedal) insertion of the anastomosis (P = .008), and intact native arterial outflow (P = .003). Twenty-three cases required major limb amputation in the follow-up period, but 17 (74%) of these had reocclusion within 30 days of thrombolysis. Only 43 grafts (47%) were found to be patent at 1-year follow-up.

Conclusions  In carefully selected cases, thrombolytic therapy is an effective means to restore limb viability in patients with occluded infrainguinal grafts. Long-term patency rates, although similar to those of surgical series, remain poor.

From the Mallinckrodt Institute of Radiology (Drs Zuckerman, Alderman, and Pilgram and Ms Idso) and the Department of Surgery (Dr Sicard), Washington University School of Medicine, St Louis, Mo. Dr Zuckerman is now with the Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.