JOURNAL OF VASCULAR SURGERY Volume 18, Number 2 Meetind abstracts 325

Harvest measurements (Petersen et al.) Harvest

measurements SHR host (n = 18)

wlm host (n = 9)

SHR sensitized (n = 6)

WRY sensitized (n = 6)

SHR treated (n = 7)

Diameter (mm) 2.8 ” 0.2 1.7 f 0.3 5.2 k 2.9 2.1 f 0.2 2.7 +- 0.2 Diameter increase (%) 82.5 k 18.4 28.0 k 20.1 210.3 f 153.2 44.4 2 14.4 72.7 + 16.7

Short-term patency (Shah et al.) Interval No. Fail PaSS Initial pateny (46) Cumuhtive patency

O-l mo 43 2 0 95.3 lOO(%) l-2 mo 41 0 0 100 95.3 2-4 mo 41 5 2 87.5 95.3 4-6 mo 34 2 6 93.5 83.4 6-9 mo 26 3 6 87.0 78.0 9-12 mo 17 0 7 100 67.8

12-18 mo 10 0 9 100 67.8 >18mo 1 0 1 100 67.8

SE

O(%) 3.2

2: 7.2 9.3

12.2 38.5

women and 17 men, with a mean age of 69 + 11 years. Comorbidities include hypertension (79%), diabetes (45%), heart disease (61%), and smoking (63%). Indica- tions for operation were limb salvage in 38 (88%) cases and claudication in five (12%).

Overall patency was determined by life-table analysis and potential predictors of patency were evaluated by logistic regression. Graft occlusion was 10 times more common in secondary reconstructions (p = 0.03) and in procedures that required anastomosis of two CSVA segments (p = 0.04). Operative indications, site of distal anastomosis, runoff, and use of postoperative anticoagu- lation did not affect patency. Short-term patency is presented in the table.

Acceptable early patency can be achieved with CSVA when autogenous vein is unavailable. Poor results seen in secondary reconstructions and bypasses that require mul- tiple segments of CSVA significantly limit the potential use of this conduit.

In this prospective study the use of thrombolysis for limb ischemia because of artery or bypass occlusion yielded good immediate results. However, limb salvage was achieved only by multiple adjunctive revascularization procedures. These data suggest that thrombolysis is not the preferred option for those patients who have a satisfactory conduit or target to bypass to.

The late outcome of a prospective study of thrombolytic treatment of native arterial and bypass graft occlusion R. T. A. Chalmers, MD, ChB, FRCSEd, T. F. Kresowik, MD, Jamal J. Hoballah, MD, William J. Sharp, MD, Alan Y. Synn, MD, and John D. Corson, MB, ChB, FRCS (Eng) , FACS, University of Iowa Hospitals 6 Clinics, Iowa City, Iowa.

Extension of limb salvage by adjunctive free tissue transfer Joseph Serletti, MD, Shepard Hurwitz, MD, Jeffrey Jones, MD, George Reading, MD, H. Raul Herrera, MD, Kenneth Ouriel, MD, and Richard M. Green, MD, University of Rochester, Rochester, N. Y.

We prospectively studied a group of 63 patients with Ischemic soft tissue wounds of the lower extremity are native artery and bypass graft occlusions after treatment limb-threatening if stable, weight-bearing soft tissue recon- with intraarterial thrombolytic therapy with urokinase. struction cannot be achieved. Before the advent of free Seventy-two infusions were performed in 47 men and 16 tissue transfer, these limb-threatening wounds were not women. There were 34 infusions in the “arterial” group and reconstructible and were treated with amputation. We 38 in the “graft” group. Mean follow-up was 32 months present our experience in 19 selected patients over the past (range 1 to 60). The immediate clinical success rate was 30 months, in whom primary amputation would have 67.5% for the arterial group and 84% for the graft group. compromised either independent activity or ambulation. The incidence of complications was 26.4%. Seventeen These patients were treated with combined vascular patients died during follow-up. Nine (29%) of 31 patients reconstruction and free tissue transfer for limb salvage.

in the arterial group had no adjunctive procedure after thrombolysis. Seven remained symptom free and two underwent a major amputation. Only two of 32 patients in the graft group underwent no additional treatment, and both have patent grafts. Twenty-one infusions were fol- lowed immediately by balloon angioplasty (11 arteries, 10 grafts). In the 35 patients who required immediate operation after thrombolysis, there were 22 new bypasses placed, 7 adjunctive surgical procedures, and 6 thrombec- tomies. The 12-month primary patency rate for the patients undergoing balloon angioplasty was 41% compared with 70% for the new bypass groupp < 0.05. Limb salvage was achieved in 86% of patients.