Son los fibrinolíticos un tratamiento útil en las reintervenciones de bypass femoropoplíteo

Summary Objective . To asses the value of thrombolytic therapy as the first option for femoropopliteal grafts occlusions, as well as to evaluate the short and midterm results. Patients and methods . From February 1990 to November 1998 we have been able to treat 53 patients with acute occlusions of femoropopliteal grafts (46 PTFE and 7 vein grafts). Mean age was 60.5 years. In all cases there were a acute non critical ischaemia of less then 15 days duration. In most of the cases the contralateral femoral approach was used. During a mean periodof 11.3 hours through an intrathrom bus catheter 4,400 IU/kg/h of Urokinase was infused. Physical examination, non-invasive techniques and angiography were used to assess efficacy. Angiography was of use in order to identify the causes for the occlusion. We could follow all our patients during a period of 24 months. Patency and limb salvage was the end point of efficacy. Other parameters were associated morbidity and morbimortality. Results . In 43/53 of grafts (81.1%) a complete lysis was achieved. The commonest cause for grafts occlusion was segmental stenosis in 70% of cases. In regards to complications, haemorrhage (16.9%) was the commonest. Despite the total lysis it was necessary to associate in 74.4% of cases some other surgical technique (8-endoluminal angioplasty). The original graft was preservedin 71.7% of patients. The 30 days patency rate was 71.7% with a limb salvage of 84.9% and death rate of 5.7%. At 24 month patency rate was 24.1%, limb salvage 82.7% and 90.6% of patients were alive. Conclusions . In acute graft occlusion of less than 15 days duration thrombolytic therapy can be afirst option as it allows us to adjourn the intervention and preserve the original graft. Nevertheless the patency rate at short and midterm is low, needing a strict follow-up.