Operative or Interventional Treatment in Infrainguinal Bypass Occlusion: Are There Predictive Factors Affecting Outcome?

Purpose: To evaluate outcome of interventional and surgical treatment in infrainguinal bypass occlusion and to identify predictive factors affecting therapeutic success. Material and Methods: Over a period of three years 96 patients with infrainguinal bypass occlusion were included in this retrospective study. 52 patients were treated by catheter-directed thrombolysis and 44 patients by reconstructive vascular surgery. Results: 41 grafts could be reopened in thrombolytic group (78.8%), thrombolysis failed in 11 cases (21.2%). 34 grafts were treated successfully by reconstructive vascular surgery (77.3%), 10 grafts couldn’t be reopened or reoccluded within 30 days after surgical therapy. After a median observation time of 14.7 months 30 of 48 (62.5%) bypass grafts treated with intraarterial thrombolysis and 19 of 27 (70.4%) grafts treated with thrombectomy were overall patent. Limb salvage was 81.3% in thrombolytic group and 88.8% in surgery group. No predictive factors affecting outcome could be identified in both groups except the localization of the occluded graft (above/below knee). Conclusion: Infrainguinal bypass occlusion is a serious and challenging complication in vascular surgery. Our study showed similar results for both therapeutic strategies. Despite our data was retrospective with a small number of patients the localization of the occluded graft as predictive pre-therapeutic factor was significant in thrombolytic and surgery group. Based on these scientific findings we established a guideline for choice of therapeutic treatment in our institution after searching current literature.