Fibrinolytic therapy for upper-extremity arterial occlusions.
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.
Widlus
D M
DM
Russell H. Morgan Department of Radiology and Radiologic Sciences, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2191.
Venbrux
A C
AC
Benenati
J F
JF
Mitchell
S E
SE
Lynch-Nyhan
A
A
Cassidy
F P
FP
Osterman
F A
FA
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*