Intra-arterial thrombin activity produced by percutaneous transluminal angioplasty eliminated by segmentally enclosed thrombolysis.
We determined the specific marker of thrombin activity, fibrinopeptide A (FPA), in the vicinity of dilated sites during percutaneous transluminal angioplasty (PTA) for femoro-popliteal obstructions in 24 patients. Blood samples were drawn proximal to dilated segments from a 4F catheter inserted retrogradely in the common femoral artery and distal to dilated segments from the balloon catheter tip. Median +/- S.E. FPA concentration was 21.5 +/- 4.4ng ml-1 before PTA. Immediately after dilatation, FPA concentrations were increased to 970.0 +/- 836.9 ng ml-1 distal to dilated segments (p less than 0.00005) and to 48.5 +/- 11.4 ng ml-1 proximally (p less than 0.003). Segmentally enclosed thrombolysis (SET) was undertaken immediately after PTA, when a double balloon catheter was positioned with a balloon at each end of dilated segments. Both balloons were inflated and 5 mg recombinant tissue plasminogen activator (rt-PA) and 1000 IU heparin were enclosed in the segments for 30 min. Immediately after SET, FPA concentration distal to dilated segments was 34.0 +/- 14.2 ng ml-1 and not different from proximal concentrations found after PTA (p = 0.57). Intense fibrinolysis was indicated by significantly increased levels of cross-linked fibrin degradation products (D-dimer) for hours after SET, but FPA concentrations in peripheral blood remained near baseline values. This finding differed from increased thrombin activity found by others during systemic thrombolytic therapy. Early rethrombosis did not occur after PTA in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Jørgensen
B
B
Department of Thoracic and Cardiovascular Surgery, Skejby Hospital, University of Aarhus, Denmark.
Nielsen
J D
JD
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D005344:Fibrinopeptide A / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D013917:Thrombin / Q000187:drug effects* / Q000378:metabolism; D015912:Thrombolytic Therapy / Q000379:methods*
D005344:Fibrinopeptide A; D013917:Thrombin