Intra-arterial urokinase as the initial therapy for acutely ischemic lower limbs.
Acute ischemia of the lower limb remains a significant risk to both life and limb. Mortality rates of approximately 10-30% and amputation rates of the same magnitude in the survivors are repeatedly reported despite advances in medical and surgical techniques. Our experience, which utilized percutaneous intra-arterial thrombolysis as the initial treatment in 72 instances (63 patients), has resulted in a markedly lower mortality rate of 1.6% and a lower amputation rate of 8.5% in the survivors. Careful categorization by clinical degree of ischemia indicates that 82% of the cases were either threatened or irreversible limb ischemia. The initial treatment with thrombolysis did not preclude subsequent prompt surgical treatment when necessary; in these cases, thrombolysis promoted improved surgical results (100%) when it was successful. It markedly reduced the need for urgent surgery, usually simplified the subsequent surgical approach, diminished the overall need for surgery, and often accomplished a successful outcome alone (31%). Significant bleeding was not noted during subsequent surgical procedures and was noted in only 2.8% of the cases. Confirmation of these results and further improvements in technique might justify the use of an initially high-dose urokinase transcatheter infusion regimen as the initial treatment of choice for acute lower-limb ischemia.
McNamara
T O
TO
University of Nevada, Medical School, Washoe Medical Center, Reno.
Bomberger
R A
RA
Merchant
R F
RF
D000208:Acute Disease; D000671:Amputation, Surgical; D004305:Dose-Response Relationship, Drug; D005260:Female; D006083:Graft Occlusion, Vascular / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000188:drug therapy* / Q000401:mortality; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
D014568:Urokinase-Type Plasminogen Activator