Therapeutic Management of Lower Extremity Arterial Bypass Graft Occlusion: Case Report

Lower extremity peripheral arterial disease is primarily caused by atherosclerosis and thromboembolic processes that alter the normal functions of the arteries of lower extremities. Surgical revascularization is indicated in patients with limb ischemia without adequate improvement by exercise rehabilitation and pharmacologic therapy and significant limitations of daily activities. Bypass graft occlusion may result due to various reasons such as: technical complication of the graft, thrombosis due to inadequate outflow of blood, myointimal hyperplasia, or progression of atherosclerosis. Intra-arterial thrombolysis is a common method of treatment in lower extremity bypass graft occlusions (Koraen). Results of a prospective, randomized trial demonstrated that thrombolysis in acutely ischemic (\u3c14 days) improved limb salvage and reduced the magnitude of the surgical procedure (Comerota). Studies demonstrated 57% success rate with streptokinase, whereas almost 90% of grafts have been successfully opened with tPA in other studies (Seabrook, Van Breda). Heparin is a useful adjunct but may increase hemorrhagic complications (Hinchliffe). If patency of the occlusion is not restored, the patient will have to be reassessed for surgical revascularization and possible amputation. Although there are guidelines available for pharmacologic management of peripheral arterial diseases, there is not a specific management of peripheral arterial bypass graft occlusion. Current treatments are based on managements of native arteries and regimens used in case reports and small studies. More studies are needed to improve prevention of bypass graft occlusions and management and monitoring after revascularization