Management of aortic bypass graft thrombosis: Utility of thrombectomy (original) (raw)
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Successful treatment of delayed aortobifemoral graft thrombosis with manual aspiration thrombectomy
Diagnostic and Interventional Radiology, 2011
S ymptomatic aortoiliac occlusions are regularly treated with aortofemoral bypass. Long-term patency of the bypass graft is very good. Early graft occlusions (within 30 days of surgery) occur in 1%-2% of patients in the postoperative period, usually because of technical difficulties with the bypass procedure. These problems are best treated with graft thrombectomy and correction of the underlying technical problem but can also be overcome by endovascular methods such as percutaneous mechanical thrombectomy with special devices and the infusion of thrombolytics. Late-graft occlusion occurs in 10%-15% of graft limbs, generally three to four years after the primary reconstruction. Late thrombosis is most commonly attributed to anastomotic intimal hyperplasia and/or progression of atherosclerotic disease in the outflow vessels (1). Surgical thrombectomy is the treatment of choice for acute or chronic thrombosis. Endovascular methods are quite effective at the acute stage of thrombosis and can be a good alternative to surgery. Chronic thrombosis of the bypass graft can be treated with surgery alone because endovascular methods are usually ineffective. As a novel alternative to surgical thrombectomy, we present the use of manual aspiration thrombectomy (MAT) for the successful recanalization of delayed occlusion of an aortobifemoral graft.
Surgical care of the arteriovenous graft: issues for the interventionalist
Techniques in Vascular and Interventional Radiology, 1999
The optimal treatment of arteriovenous (AV) grafts requires a multidisciplinary approach to the management of graft pathology. Open surgical and percutaneous methods must complement each other. Patient care can be enhanced if the indications, strengths, and weaknesses of a given technique are understood by all those involved in patient care. Continued study of the relative efficacy of the various techniques and clinical algorithms is indicated so that the most appropriate procedure is undertaken for a given pathology. This article reviews graft pathology treated via open surgical intervention. The interventionalist must have a thorough understanding of surgical treatment options so that an appropriate and timely referral can be made. The need for the interventionalist to evaluate a wide range of graft pathology and to decide on the most appropriate treatment is becoming more important, because in many institutions, the interventionalist has become the primary referral physician for AV graft dysfunction.
Diagnostic and Interventional Radiology, 2013
The purpose of this study was to present our experience with guiding catheters in manual aspiration thrombectomy of occluded infra-aortic bypass grafts. This material was designed as a guiding catheter but was also used for thrombus aspiration. Six consecutive patients (all male; mean age, 61.0±5.7 years; range, 54-68 years) who underwent manual aspiration thrombectomy at the discretion of the operator for infra-aortic bypass graft thrombosis between 2002 and 2010 were retrospectively reviewed. The angiographic success described as either stenosis or residual thrombus less than 30% was 67%. Primary patency was 50%, and secondary patency was 66.7%. Additional stents were needed in four lesions of three patients. Manual aspiration thrombectomy is intended to remove both soft acute blood clots and hard organized embolic and thrombotic obstructions. Manual aspiration thrombectomy appears to be a safe and effective method for treating delayed graft thrombosis. This method provides an alternative to surgical thrombectomy, especially for patients who are not good candidates for the surgery.
Patency Following Successful Thrombolysis of Occluded Vascular Grafts
European Journal of Vascular and Endovascular Surgery, 2001
Aim: to determine patency after successful lysis of occluded bypass grafts. Methods: data were collected from four centres with a wide experience of thrombolysis. Outcome following successful lysis was determined from prospectively collected data or case notes. Data from 75 patients, 53 men, were analysed. Results: median age at time of lysis was 68 years (range 33-88). Median age of graft was 12 months (range 1-120). Patency at 12 months was 33% (95% conf. interval: 21-44%). There were no differences in patency depending on whether the graft was above or below the inguinal ligament or whether an additional procedure eg. percutaneous or vein patch angioplasty was carried out. However in those 48 cases when lysis was deemed complete, i.e. there was restoration of graft patency and at least one vessel run off patency at 12 months was 39% compared with 17% if lysis was incomplete (p=0.04). Conclusions: at the present time it is difficult to justify routine thrombolysis of occluded grafts when patency, based on intention to treat, is approximately 20% at one year. Following successful graft lysis the role of anticoagulation and careful graft surveillance require further investigation.
Circulation, 1979
Early and late (range 5-73 months, average 2.5 years) postoperative arteriographic studies were performed in 85 patients after saphenous vein aortocoronary bypass surgery. In a prior study (< 2 weeks postoperative) of 570 patients with 1197 grafts, arteriography revealed 89.6% early patency of grafts. Late follow-up in 85 patients discharged with all grafts patent revealed 92.2% still patent, an annual mean graft attrition rate (percent of grafts closed/year) of 3.2%/year. This mean graft attrition rate was only slightly affected by regrouping patients according to the interval between the two postoperative studies; however, recurrent angina pectoris was influenced by vein graft attrition. Thus, in 36 patients restudied because of recurrent angina pectoris, the attrition rate was 6.1%/year, compared with 1.1%/year in 49 patients without angina. Progressive coronary artery disease (41% vs 18%), graft closure (22% vs 4%) and incomplete revascularization (39% vs 16%) were significantly more frequent in those with recurrent angina. The frequency of progressive coronary disease was directly related to the duration of follow-up (i.e., the longer the follow-up the higher the frequency of progressive disease). The mean annual rate of progressive coronary disease in arteries not grafted was 11.8%/year. Kinking or graft stenosis was observed in 3.1% of grafts in the early study, while late localized graft narrowing was observed in 8%. At late follow-up, most patent grafts were uniformly narrowed and foreshortened. The mean graft diameter decreased by 17% at late follow-up, and 25% of grafts had at least 25% reduction in mean diameter; however, the mean graft diameter/mean recipient artery diameter ratio exceeded 1.0 in all but one graft. The graft/artery diameter ratio at late follow-up was over 1.5 in 71% of the grafts. The mean graft blood flow determined by cinedensitometric methods revealed a 30% or more reduction in blood flow in 35% of grafts, compared with early postoperative measurements.
Annals of Vascular Surgery, 2009
consecutive patients (708 men, 114 women; mean age 63.8 years) underwent aortoiliac or aortofemoral reconstruction using a bifurcated ePTFE stretch graft. Preoperatively, all patients had ultrasonographic and arteriographic evaluations and were divided into groups according to the TASC II morphological stratification of iliac lesions. Seventy-seven patients (9.4%) had type B lesions, 314 (38.2%) had type C lesions, and 431 (52.4%) were classified as type D lesions. Endarterectomy of the aorta was required in 172 patients (21%); femoral arteries were endarterectomized in 222 (27%). Femoropopliteal bypass grafting was performed in 18 patients, aortorenal bypass in 12, and mesenteric artery grafting in one. One patient died perioperatively of a myocardial infarction. Perioperative morbidity included cardiac (2.2% of patients), respiratory (0.9%), and gastrointestinal (1.2%) complications, as well as acute renal insufficiency (1.3%). Seven patients had bleeding requiring surgical revision within the first 24 hr after surgery. There were four cases (0.5%) of immediate graft thrombosis and five (0.6%) of single-limb graft thrombosis. During a mean follow-up time of 72 months (range 28-170), 58 patients (7.1%) were lost to follow-up and 205 patients (24.9%) died. The primary and secondary graft-patency rates during the observation period were 90.6% and 97.9%, respectively. Twelve late graft occlusions resolved after thrombectomy alone. Eleven cases of single-limb late thrombosis resolved after thrombectomy and profundoplasty. The limb-salvage rate during the observation period in patients who underwent operation for critical limb ischemia was 84.5%. There were nine postoperative graft infections (1.1% infection rate) in the series. Our long-term experience with ePTFE stretch grafts in aortoiliac and aortofemoral reconstruction shows that these prostheses have a high rate of patency and a low rate of graft-related complications.