Direct puncture versus contralateral femoral artery approach for catheter-directed thrombolysis of occluded infra-inguinal arterial bypass grafts

AIM: To compare the safety, effectiveness, and clinical outcome of percutaneous direct puncture approach versus contralateral femoral native vessel approach for catheter-directed thrombolysis of occluded infra-inguinal bypass grafts. MATERIALS AND METHODS: A retrospective analysis was performed comprising a cohort of patients who underwent catheter-directed thrombolysis procedures of occluded infra-inguinal bypass grafts between January 2013 and January 2022, with a follow-up period until June 2022. This included 55 procedures via the native vessel approach and 18 procedures via the direct puncture approach. Primary outcomes were technical success and procedural safety; secondary outcomes included re-intervention rate, limb salvage, and mortality as assessed by log-rank testing and Kaplan-Meier curves. RESULTS: There were no differences between the two groups with regard to patient de-mographics, except for the number of previous vascular procedures (n=6.83 +/- 3.07 direct approach versus n=4.96 +/- 2.79 native vessel approach, p=0.025). Thrombolysis was compa-rably successful in both groups (n=13/18; 72% direct approach versus n=42/55; 76%, p=0.723). There were no differences in the duration of thrombolysis administration. The rate of adverse events was slightly lower in the direct approach group, but without significance (p=0.092). There were no adverse events related to the puncture site in the direct approach group. No differences were found between the time-to-event values for re-occlusion, re-intervention, amputation, or mortality respectively (p=0.662; p=0.520; p=0.816; p=0.462). CONCLUSION: The direct puncture approach seems to be a safe and efficient approach for catheter-directed thrombolysis procedures in infra-inguinal occluded bypass grafts, with clinical outcomes comparable to the native vessel approach. (c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Automated summary

This study compared the safety and effectiveness of percutaneous direct puncture approach and contralateral femoral native vessel approach for catheter-directed thrombolysis of occluded infra-inguinal bypass grafts. The results showed that the direct puncture approach is a safe and efficient method with comparable clinical outcomes to the native vessel approach. The rate of adverse events was slightly lower in the direct approach group, but without significance.