Is It Worthwhile Treating Occluded Cold Stored Venous Allografts by Thrombolysis?

Abstract

Thrombolysis has been reported to be suboptimal in occluded vein grafts and cryopreserved allografts, and there are no data on the efficacy of thrombolysis in occluded cold stored venous allografts. The aim was to evaluate early outcomes, secondary patency and limb salvage rates of thrombolysed cold stored venous allograft bypasses and to compare the outcomes with thrombolysis of autologous bypasses. This was a single center study of consecutive patients with acute and non-acute limb ischemia between September 1, 2000, and January 1, 2014, with occlusion of cold stored venous allografts, and between January 1, 2012, and January 1, 2014, with occlusion of autologous bypass who received intra-arterial thrombolytic therapy. Sixty-one patients with occlusion of an infrainguinal bypass using a cold stored venous allograft (n=35) or an autologous bypass (n=26) underwent percutaneous intra-arterial thrombolytic therapy. The median duration of thrombolysis was 20h (IQR 18-24) with no difference between the groups (p=.14). The median follow up was 18.5 months (IQR 11.0-52.0). Secondary patency rates of thrombolysed bypass at 6 and 12 months were 44±9% and 32±9% in patients with a venous allograft bypass and 46±10% and 22±8% with an autologous bypass, with no difference between groups (p=.40). Limb salvage rates at 1, 6, and 12 months after thrombolysis in the venous allograft group were 83±7%, 72±8% and 63±9%, and in the autologous group 91±6%, 76±9%, and 65±13%, with no difference between groups (p=.69). Long-term results of thrombolysis of venous allograft bypasses are similar to those of autologous bypasses. Occluded cold stored venous allograft can be successfully re-opened in most cases with a favorable effect on limb salvage.