Intra-arterial urokinase infusion in diabetic patients with rapidly progressive ischemic foot lesions.
OBJECTIVE
The effectiveness of local intra-arterial thrombolysis by urokinase was evaluated in eight non-insulin-dependent diabetic patients with angiographic evidence of infrapopliteal occlusive disease and rapidly progressive foot lesions.


METHODS
With an electric peristaltic pump, urokinase was infused for 96 h by a 5-6 F catheter introduced into the femoral artery and placed immediately above the occluded infrapopliteal arteries. After baseline, angiography was repeated at 24- to 48-h intervals and at conclusion of the treatment.


RESULTS
Six patients showed immediate improvement of clinical symptoms. Angiography revealed the reestablishment of blood flow in collateral vessels of the leg and foot in the dorsal pedal artery in three patients and in the plantar arch in two. Recanalization of the major arteries of the trifurcation was not achieved. After 12 mo of follow-up, all limbs were salvaged, although four patients required vascular reconstruction to further improve foot perfusion and complete healing.


CONCLUSIONS
Intra-arterial urokinase, which opens collateral and smaller vessels of the leg and foot in patients with diabetes, may be effective in improving blood flow in lower extremities and in making the patient a better candidate for vascular surgery.
Vannini
P
P
Department of Metabolic Diseases, St. Orsola University Hospital, Bologna, Italy.
Ciavarella
A
A
Mustacchio
A
A
Rossi
C
C
D000368:Aged; D003925:Diabetic Angiopathies / Q000188:drug therapy*; D004341:Drug Evaluation; D005260:Female; D005528:Foot / Q000098:blood supply*; D005534:Foot Diseases / Q000188:drug therapy*; D006801:Humans; D007511:Ischemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D014568:Urokinase-Type Plasminogen Activator