Evaluation and complications of direct graft puncture in thrombolysis and other interventional techniques

Purpose: To evaluate the value and complications of direct graft puncture in conducting interventional procedures in synthetic vascular bypass grafts. Methods: We retrospectively reviewed 65 direct graft punctures in 50 patients undergoing a variety of interventional vascular procedures. In two patients the grafts were found to be infected and the procedures abandoned. Results: Complications encountered included hematomas that did not require treatment in three patients, and four hematomas requiring surgical drainage. One graft became infected (despite prophylactic cefuroxime), after three consecutive punctures over a 10-day period for a variety of interventions. All the patients who developed hematomas had undergone pharmacological thrombolysis. Conclusion: Direct graft puncture is a relatively safe technique, with a minimal risk of infection and hemostatic complications attributable to thrombolysis. In 31 of the 41 patients undergoing successful thrombolysis, additional percutaneous procedures were undertaken, and these were facilitated by the direct graft puncture route.