Thrombolysis of infrapopliteal bypass grafts: efficacy and underlying angiographic pathology.

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Abstract
The purpose of this study was to determine retrospectively the effectiveness of thrombolysis of occluded infrapopliteal bypass grafts and to identify factors affecting success.The records of 52 consecutive patients (52 grafts) who underwent selective urokinase thrombolysis of grafts to the pedal or tibial arteries were reviewed. The need for subsequent surgery and the influence of diabetes on outcome were analyzed.There were 43 vein and nine Goretex (W-L Gore, Flagstaff, AZ) and vein composite grafts inserting into tibial and peroneal arteries (n = 28) or pedal arteries (n = 24). Mean time of follow-up was 19 months. All grafts were entered, and technical success was achieved in 73% of patients. Twenty-six patients required some form of graft revision. Overall patency at 30 days was 76%. Thirty-day limb-salvage and mortality rates were 82% and 4%, respectively. No significant difference was found in 1-yr outcomes between diabetic and nondiabetic patients or between pedal and tibial grafts. Major complicat...

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