Thrombolysis for occluded vein bypass grafts through surgical access.

Purpose: This report describes surgical access to occluded vein grafts for thrombolysis by direct cutdown where indirect angiographic techniques have failed.

Method: A sheath is introduced directly into the proximal vein graft. Distal thrombus is lysed following standard protocol. The residual thrombus at the origin of the graft is removed surgically, and the area is closed with a patch angioplasty.

Results: Distal thrombus was completely lysed in two vein grafts without bleeding complications.

Conclusion: The thrombus "cork" that forms at the upper end of an occluded vein graft may deflect the angiographer's guide wire, but the distal thrombus usually remains soft and amenable to lysis. Angiographic access should not be a limiting factor in thrombolysis of an occluded vein graft.