Efficacy and Safety of Urokinase versus Alteplase in VIABAHN Stent-Graft Thrombolysis

Objectives: Evaluation of efficacy and safety of urokinase and alteplase for intra-arterial thrombolysis therapy for thrombosed VIABAHN stent-graft (SG) endoprosthesis in the femoropopliteal tract. Methods: In this retrospective study, 96 target limbs were included and analyzed with thrombosed 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 by comparing the use of alteplase and urokinase. Results: The cohort (N = 96, 78.1% male, median age 70 years (63 - 76)) included 26 (27.1%) limbs treated with urokinase and 70 (72.9%) with alteplase. The average time to occlusion was 15.5 months (3.0 - 36.3). Alteplase exhibited a shorter treatment time (26.13 ± 9.37 hours) compared to 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 one-year patency (13.9%) than alteplase (36.6%) (P = 0.06). One-year patency for the entire cohort was 29.8%. Conclusion: Both urokinase and alteplase proved equally effective and safe for treating thrombosed VIABAHN SGs, with a slight preference 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.