Operative or Interventional Treatment in Infrainguinal Bypass Occlusion: Are There Predictive Factors Affecting Outcome?

T. Betz, C. Uhl, M. Steinbauer, N. Zorger, I. Töpel

Department of Radiology, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.
Department of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.

DOI: 10.4236/ss.2012.310094                

Abstract

Purpose: To evaluate outcome of interventional and surcigal treatment in infrainguinal bypass occlusion and to identify predictive factors affecting therapeutic success. Material and Methods: Over a period of three years 96 patients with infrainguinal bypass occlusion were included in this retrospective study. 52 patients were treated by catheter-directed thrombolysis and 44 patients by reconstructive vascular surgery. Results: 41 grafts could be reopened in thrombolytic group (78.8%), thrombolysis failed in 11 cases (21.2%). 34 grafts were treated successfully by reconstructive vascular surgery (77.3%), 10 grafts couldn’t be reopened or reoccluded within 30 days after surcical therapy. After a median observation time of 14.7 months 30 of 48 (62.5%) bypass grafts treated with intraarterial thrombolysis and 19 of 27 (70.4%) grafts treated with thrombectomy were overall patent. Limb salvage was 81.3% in thrombolytic group and 88.8% in surgery group. No predictive factors affecting outcome could be identified in both groups except the localization of the occluded graft (above/below knee). Conclusion: Infrainguinal bypass occlusion is a serious and challenging complication in vascular surgery. Our study showed similar results for both therapeutic strategies. Despite our data was retrospective with a small number of patients the localization of the occluded graft as predictive pretherapeutic factor was significant in thrombolytic and surgery group. Based on these scientific findings we established a guideline for choice of therapeutic treatment in our institution after searching current literature.

Keywords

Thrombolytic Therapy; Bypass occlusion; Percutaneous Intervention; Bypass Thrombectomy

Conflicts of Interest

The authors declare no conflicts of interest.

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