title: Fibrinolytic therapy for upper-extremity arterial occlusions.
abstract: Acute upper-extremity arterial occlusion may be due to embolic phenomena or de novo thrombosis. If the occlusion is left untreated, claudication or ischemia necessitating amputation can occur. Operative Fogarty-balloon embolectomy has been the treatment of choice for this entity. In a 6-year period the authors used fibrinolysis on nine occasions in eight patients to treat acute upper-extremity arterial occlusions. Concomitant balloon angioplasty was helpful in four cases. Success, defined as a normal hand with at least one artery that was continuously patent to the wrist, was achieved in all patients. A single significant groin hematoma was seen. Neither stroke nor death occurred in any case, and no amputations were necessary. Local transcatheter intraarterial administration of urokinase can be considered a first-line treatment for brachial artery embolus and other causes of acute upper-extremity arterial occlusion.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiologic Sciences, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2191.
authors.forename: D M
authors.initials: DM
authors.lastname: Widlus
authors.forename: A C
authors.initials: AC
authors.lastname: Venbrux
authors.forename: J F
authors.initials: JF
authors.lastname: Benenati
authors.forename: S E
authors.initials: SE
authors.lastname: Mitchell
authors.forename: A
authors.initials: A
authors.lastname: Lynch-Nyhan
authors.forename: F P
authors.initials: FP
authors.lastname: Cassidy
authors.forename: F A
authors.initials: FA
authors.lastname: Osterman
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001132:Arm / Q000098:blood supply*; D001366:Axillary Artery / Q000000981:diagnostic imaging; D001916:Brachial Artery / Q000000981:diagnostic imaging; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*