Zwarts, S.A. (2024) Efficacy and Safety Unveiled: Urokinase versus Alteplase in VIABAHN Stent-Graft Thrombolysis. thesis, Medicine.
Full text available on request.Abstract
Abstract English Objectives: To evaluate and compare the efficacy and safety of urokinase and alteplase for intra-arterial thrombolysis therapy for thromboses VIABAHN stent-graft (SG) endoprosthesis in the femoropopliteal tract. Methods: A retrospective review analyzed 96 target limbs with thrombosed VIABAHN SGs in the femoropopliteal tract treated with intra-arterial thrombolysis between January 2016 and August 2023. Short- and long-term efficacy and safety were examined, as well as the effect of possible risk factors on restenosis. Results: The cohort (N=96, 78.1% male, median age 70 years (63-76)) included 26 (27%) limbs treated with urokinase and 70 (73%) with alteplase. The average time to occlusion measured 15.5 months (3.0-36.3). Alteplase exhibited a shorter treatment time (26.13 ± 9.37 hours) than urokinase (30.58 ± 9.07 hours) (P=0.04). Success rates, after additional interventions, were 93.3% for urokinase and 90.0% for alteplase (P=0.73). Major complication and amputation rates were 9.2% and 7.3%, respectively. Urokinase had a lower patency (13.9%) than alteplase (36.6%) (P=0.06). One-year patency for the entire cohort was 29.8%. A 5 mm stent diameter increased restenosis risk compared to 6 mm (OR=0.25, 95% CI 0.08-0.74; P=0.01). Other risk factors were not identified. Conclusion: Both urokinase and alteplase proved equally effective and safe for treating thrombosed VIABAHN SGs, with a slight advantage for alteplase based on treatment time. However, low patency rates and high complication and amputation rates highlight the need for additional interventions, proper indication, and strict follow-up.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Walraven, drs. L. van |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Feb 2025 12:20 |
| Last Modified: | 25 Feb 2025 12:20 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3807 |
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