Thrombolysis of occluded femoropopliteal grafts

G. A. Gardiner, Walter Koltun, K. Kandarpa, A. Whittemore, M. F. Meyerovitz, M. A. Bettmann, D. C. Levin, D. P. Harrington

Research output: Contribution to journalArticle

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Abstract

In a series of 44 occluded femoropopliteal grafts, streptokinase was used for thrombolytic therapy in 22 cases and urokinase in 22 cases. In most cases, thrombolytic agents were administered via an indwelling arterial catheter directly into the proximal thrombus. The catheter tip was advanced as thrombolysis occurred. Compared with streptokinase infusions, urokinase bolus injection followed by infusion had better results (77% vs 41%) and fewer complications (23% vs 50%). During thrombolytic infusion, concomitant heparin infusion was usually used to reduce the frequency of thrombus formation on the infusion catheter or recurrent thrombosis of the graft, once the tip of the infusion catheter was advanced distally. Follow-up in 23 of 26 successful cases showed that 11 of the grafts remained open at an average follow-up of 12 months or until the patient died. The 12 grafts that reoccluded remained open an average of 3 months. In none of the 18 failures was simple surgical thrombectomy or thrombectomy with graft revision effective in revascularizing the distal limb. The advantages of thrombolysis compared with thrombectomy are less trauma to the graft, which is especially important in vein grafts, and improved distal runoff due to lysis of infrapopliteal thrombus. Even among cases considered failures in this series, the surgical approach was often simplified because of parital thrombolysis. Thrombolysis requires a considerable amount of time, effort, and expense, but in certain patients where thrombectomy is indicated for the treatment of occluded femoropopliteal grafts, this technique offers important advantages.

Original languageEnglish (US)
Pages (from-to)621-626
Number of pages6
JournalAmerican Journal of Roentgenology
Volume147
Issue number3
DOIs
StatePublished - Jan 1 1986

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Transplants
Thrombectomy
Thrombosis
Streptokinase
Catheters
Urokinase-Type Plasminogen Activator
Indwelling Catheters
Fibrinolytic Agents
Thrombolytic Therapy
Heparin
Veins
Extremities
Injections
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Gardiner, G. A., Koltun, W., Kandarpa, K., Whittemore, A., Meyerovitz, M. F., Bettmann, M. A., ... Harrington, D. P. (1986). Thrombolysis of occluded femoropopliteal grafts. American Journal of Roentgenology, 147(3), 621-626. https://doi.org/10.2214/ajr.147.3.621
Gardiner, G. A. ; Koltun, Walter ; Kandarpa, K. ; Whittemore, A. ; Meyerovitz, M. F. ; Bettmann, M. A. ; Levin, D. C. ; Harrington, D. P. / Thrombolysis of occluded femoropopliteal grafts. In: American Journal of Roentgenology. 1986 ; Vol. 147, No. 3. pp. 621-626.
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abstract = "In a series of 44 occluded femoropopliteal grafts, streptokinase was used for thrombolytic therapy in 22 cases and urokinase in 22 cases. In most cases, thrombolytic agents were administered via an indwelling arterial catheter directly into the proximal thrombus. The catheter tip was advanced as thrombolysis occurred. Compared with streptokinase infusions, urokinase bolus injection followed by infusion had better results (77{\%} vs 41{\%}) and fewer complications (23{\%} vs 50{\%}). During thrombolytic infusion, concomitant heparin infusion was usually used to reduce the frequency of thrombus formation on the infusion catheter or recurrent thrombosis of the graft, once the tip of the infusion catheter was advanced distally. Follow-up in 23 of 26 successful cases showed that 11 of the grafts remained open at an average follow-up of 12 months or until the patient died. The 12 grafts that reoccluded remained open an average of 3 months. In none of the 18 failures was simple surgical thrombectomy or thrombectomy with graft revision effective in revascularizing the distal limb. The advantages of thrombolysis compared with thrombectomy are less trauma to the graft, which is especially important in vein grafts, and improved distal runoff due to lysis of infrapopliteal thrombus. Even among cases considered failures in this series, the surgical approach was often simplified because of parital thrombolysis. Thrombolysis requires a considerable amount of time, effort, and expense, but in certain patients where thrombectomy is indicated for the treatment of occluded femoropopliteal grafts, this technique offers important advantages.",
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Gardiner, GA, Koltun, W, Kandarpa, K, Whittemore, A, Meyerovitz, MF, Bettmann, MA, Levin, DC & Harrington, DP 1986, 'Thrombolysis of occluded femoropopliteal grafts', American Journal of Roentgenology, vol. 147, no. 3, pp. 621-626. https://doi.org/10.2214/ajr.147.3.621

Thrombolysis of occluded femoropopliteal grafts. / Gardiner, G. A.; Koltun, Walter; Kandarpa, K.; Whittemore, A.; Meyerovitz, M. F.; Bettmann, M. A.; Levin, D. C.; Harrington, D. P.

In: American Journal of Roentgenology, Vol. 147, No. 3, 01.01.1986, p. 621-626.

Research output: Contribution to journalArticle

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T1 - Thrombolysis of occluded femoropopliteal grafts

AU - Gardiner, G. A.

AU - Koltun, Walter

AU - Kandarpa, K.

AU - Whittemore, A.

AU - Meyerovitz, M. F.

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N2 - In a series of 44 occluded femoropopliteal grafts, streptokinase was used for thrombolytic therapy in 22 cases and urokinase in 22 cases. In most cases, thrombolytic agents were administered via an indwelling arterial catheter directly into the proximal thrombus. The catheter tip was advanced as thrombolysis occurred. Compared with streptokinase infusions, urokinase bolus injection followed by infusion had better results (77% vs 41%) and fewer complications (23% vs 50%). During thrombolytic infusion, concomitant heparin infusion was usually used to reduce the frequency of thrombus formation on the infusion catheter or recurrent thrombosis of the graft, once the tip of the infusion catheter was advanced distally. Follow-up in 23 of 26 successful cases showed that 11 of the grafts remained open at an average follow-up of 12 months or until the patient died. The 12 grafts that reoccluded remained open an average of 3 months. In none of the 18 failures was simple surgical thrombectomy or thrombectomy with graft revision effective in revascularizing the distal limb. The advantages of thrombolysis compared with thrombectomy are less trauma to the graft, which is especially important in vein grafts, and improved distal runoff due to lysis of infrapopliteal thrombus. Even among cases considered failures in this series, the surgical approach was often simplified because of parital thrombolysis. Thrombolysis requires a considerable amount of time, effort, and expense, but in certain patients where thrombectomy is indicated for the treatment of occluded femoropopliteal grafts, this technique offers important advantages.

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Gardiner GA, Koltun W, Kandarpa K, Whittemore A, Meyerovitz MF, Bettmann MA et al. Thrombolysis of occluded femoropopliteal grafts. American Journal of Roentgenology. 1986 Jan 1;147(3):621-626. https://doi.org/10.2214/ajr.147.3.621