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Differential mechanisms of failure of autogenous and non-autogenous bypass conduits: an assessment following successful graft thrombolysis.

Publication ,  Journal Article
Ouriel, K; Shortell, CK; Green, RM; DeWeese, JA
Published in: Cardiovasc Surg
October 1995

The advent of graft thrombolysis has provided an objective means for evaluating the etiology of graft occlusion. Over a 10-year period, intra-arterial urokinase (102 cases) or streptokinase (seven cases) was used in 109 infrainguinal conduits (30 autogenous and 79 non-autogenous) that failed 30 days or more after implantation. Thrombolysis was not achieved in 19 additional graft occlusions; these cases were excluded from study because of an inability to define the mechanism of failure. Non-invasive laboratory data were available within 6 months of graft occlusion in 82 (75%) of the cases, with Doppler segmental studies in 80 cases (73%) and duplex ultrasonography studies in 39 cases (36%). Pre-failure non-invasive laboratory abnormalities were detected more frequently in autogenous grafts (21 of 24 patients, 88%), while non-autogenous grafts usually occluded without prior hemodynamic change (11 of 58 patients had abnormalities, 19%) (P < 0.001). Thrombolysis uncovered anatomic defects responsible for thrombosis in 27 (90%) of 30 autogenous grafts compared with only 32 (41%) of non-autogenous conduits (P < 0.001). The most common lesions underlying autogenous graft failure comprised stenoses within the body of the graft (11 cases, 37%), while the most common lesions in failed non-autogenous grafts appeared to be stenoses at an anastomosis (21 cases, 27%). Thus, the mechanisms underlying the late failure of autogenous and non-autogenous grafts differ markedly; autogenous grafts most commonly fail as a result of the gradual development of lesions intrinsic to the graft, while non-autogenous grafts fail precipitously, presumably as a result of some non-anatomic mechanism.

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Published In

Cardiovasc Surg

DOI

ISSN

0967-2109

Publication Date

October 1995

Volume

3

Issue

5

Start / End Page

469 / 473

Location

England

Related Subject Headings

  • Veins
  • Urokinase-Type Plasminogen Activator
  • Ultrasonography, Doppler, Duplex
  • Ultrasonography, Doppler
  • Thrombosis
  • Thrombolytic Therapy
  • Streptokinase
  • Middle Aged
  • Male
  • Leg
 

Citation

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Ouriel, K., Shortell, C. K., Green, R. M., & DeWeese, J. A. (1995). Differential mechanisms of failure of autogenous and non-autogenous bypass conduits: an assessment following successful graft thrombolysis. Cardiovasc Surg, 3(5), 469–473. https://doi.org/10.1016/0967-2109(95)94443-z
Ouriel, K., C. K. Shortell, R. M. Green, and J. A. DeWeese. “Differential mechanisms of failure of autogenous and non-autogenous bypass conduits: an assessment following successful graft thrombolysis.Cardiovasc Surg 3, no. 5 (October 1995): 469–73. https://doi.org/10.1016/0967-2109(95)94443-z.
Ouriel, K., et al. “Differential mechanisms of failure of autogenous and non-autogenous bypass conduits: an assessment following successful graft thrombolysis.Cardiovasc Surg, vol. 3, no. 5, Oct. 1995, pp. 469–73. Pubmed, doi:10.1016/0967-2109(95)94443-z.
Journal cover image

Published In

Cardiovasc Surg

DOI

ISSN

0967-2109

Publication Date

October 1995

Volume

3

Issue

5

Start / End Page

469 / 473

Location

England

Related Subject Headings

  • Veins
  • Urokinase-Type Plasminogen Activator
  • Ultrasonography, Doppler, Duplex
  • Ultrasonography, Doppler
  • Thrombosis
  • Thrombolytic Therapy
  • Streptokinase
  • Middle Aged
  • Male
  • Leg