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

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.

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T. Betz, C. Uhl, M. Steinbauer, N. Zorger and I. Töpel, "Operative or Interventional Treatment in Infrainguinal Bypass Occlusion: Are There Predictive Factors Affecting Outcome?," Surgical Science, Vol. 3 No. 10, 2012, pp. 473-478. doi: 10.4236/ss.2012.310094.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] E. B. Dreglid, et al., “Patient Survival and Limb Prognosis after Arterial Embolectomy,” European Journal of Vascular Surgery, Vol. 1, No. 4, 1987, pp. 263-271. doi:10.1016/S0950-821X(87)80078-6
[2] A. J. Comerota, F. A. Weaver, J. D. Hosking, et al., “Results of a Prospective, Randomized Trial of Surgery versus Thrombolysis for Occluded Lower Extremity Bypass Grafts,” American Journal of Surgery, Vol. 172, No. 2, 1996, pp. 105-112. doi:10.1016/S0002-9610(96)00129-8
[3] K. Ouriel, et al., “Acute Peripheral Arterial Occlusion: Predictors of Success in Catheter-Directed Thrombolytic Therapy,” Radiology, Vol. 193, No. 2, 1994, pp. 561-566.
[4] K. Ouriel and F. J. Veith, “Acute Lower Limb Ischemia: Determinants of Outcome,” Surgery, Vol. 124, No. 2, 1998, pp. 336-342
[5] STILE Investigators, “Results of a Prospective Randomized Trial Evaluating Surgery versus Thrombolysis for Ischemia of the Lower Extremity. The STILE Trial,” Annals of Surgery, Vol. 220, No. 3, 1994, pp. 251-266. doi:10.1097/00000658-199409000-00003
[6] J. C. van den Berg, “Thrombolysis for Acute Arterial Occlusion,” Journal of Vascular Surgery, Vol. 52, No. 2, 2010, pp. 512-515.
[7] M. F. Conrad, et al., “Long-Term Results of Catheter-Directed Thrombolyis to Treat Infrainguinal Bypass Graft Occlusion: The Urokinase Era,” Journal of Vascular Surgery, Vol. 37, No. 5, 2003, pp. 1009-1016. doi:10.1067/mva.2003.176
[8] R. K. Greenberg and K. Ouriel, “A Multi-Modal Approach to the Management of Bypass Graft Failure,” Vascular Medicine, Vol. 3, No. 3, 1998, pp. 215-220. doi:10.1177/1358836X9800300306
[9] H. D. Berkowitz and J. C. Kee, “Occluded Infrainguinal Grafts: When to Choose Lytic Therapy versus a New Bypass Graft,” The American Journal of Surgery, Vol. 170, No. 2, 1995, pp. 136-139. doi:10.1016/S0002-9610(99)80272-4
[10] C. K. Shorttell and K. Ouriel, “Thrombolysis in Acute Peripheral Arterial Occlusion: Predictors of Immediate Success,” Annals of Vascular Surgery, Vol. 8, No. 1, 1994, pp. 59-65. doi:10.1007/BF02133407

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