[Results of thrombectomy for prosthetic graft occlusion. A five-years consecutive experience].

OBJECTIVES: Evaluation of graft thrombectomies performed at our department, during a five years' consecutive period. METHODS: Charts of all consecutive graft thrombosis treated with surgical thrombectomy at our department between June/2006 and September/2011 were retrospectively reviewed. Thrombectomy primary patency, limb salvage and mortality rates were estimated by the Kaplan-Meier method. Differences among subgroups were tested by the Log-Rank test for time-dependent outcomes. RESULTS: A total of 57 cases were studied. Median follow-up time was 387 days. Survival rate was 84,2% at 358 days (SD=6,1%). Thrombectomy primary patency rates were 17,9 % at 1 year (SD=6,5%). Limb-salvage rates were 56,6% at 1 month (SD=6,9%) and 40,3% at 4,5 years (SD=7,1%). Re-intervention rates were 52,2% at 4,5 years and among those who were reoperated on, limb-salvage rates were 71,4% at 12 days (SD=9,9%). To assess the differences according to the type of graft operated on, cases were placed into two groups: one group included those thrombectomies performed by occlusion of any bypass for aorto-iliac revascularization (aortobifemoral, femoro-femoral, femoro-popliteal crossover, axilo-unifemoral and axilo-bifemoral) and the other group included all the others (for infra-inguinal revascularization). The first group exhibited lower survival rates (85,1% vs 96,3% at 11 days, SD<10%, p=0.024). On the other hand, this group presented higher patency rates comparing to infra-inguinal revascularization group (58,5% vs 81,3% %, SD<10%, p=0,006). Regarding limb-salvage and re-intervention rates, there were no significant differences between these two groups. Interval time between bypass surgery and thrombectomy for its occlusion had no impact on patency, neither the additional measures used along with thrombectomy for revascularization after occlusion. CONCLUSION: RESULTS of surgical thrombectomies after graft thrombosis are discouraging. Other techniques such as thrombolysis must be kept in mind in order to achieve better outcomes. In some patients one must decide wether to proceed with an attempt to salvage the initial procedure or to amputation, which may speed the patient toward the best possible outcome.