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August 1992

Management of Infrainguinal Occluded Vein Bypasses With a Combined Approach of Thrombolysis and Surveillance: A Prospective Study

Author Affiliations

From the Section of Vascular Surgery, Department of Surgery (Drs Miller, Sharp, Hoballah, Kresowik, and Corson, and Mr Brummer), and the Section of Interventional Radiology, Department of Radiology (Drs Cragg, Smith, and Hakagawa), The University of Iowa Hospitals and Clinics, Iowa City.

Arch Surg. 1992;127(8):986-989. doi:10.1001/archsurg.1992.01420080120020

• Intra-arterial thrombolysis with urokinase was attempted on 23 occluded infrainguinal vein bypasses. Lesions revealed by thrombolysis included 11 anastomotic stenoses, five midbypass stenoses, five native artery stenoses, and five unusable diffusely stenotic vein conduits. Adjunctive procedures performed immediately after successful thrombolysis included 10 local surgical revisions, five balloon angioplasties, and five new vein bypasses. Three nonanastomotic vein bypass stenoses and two common iliac artery stenoses were detected using a surveillance protocol in subsequent follow-up of patients with patent bypasses. Twelve-month patency following thrombolysis (including immediate failures) was 52.4%. The use of thrombolysis in the management of occluded vein bypasses allows the identification and correction of pathological lesions. Once revised, continued vein bypass patency may be improved with a surveillance program.

(Arch Surg. 1992;127:986-989)

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