Intraoperative intra-arterial urokinase infusion as an adjunct to Fogarty catheter embolectomy in acute arterial occlusion.
Sixteen patients, seven men and nine women (mean age of 66 years), with acute arterial ischemia were treated with operative thromboembolectomy by Fogarty catheterization and urokinase. Seven patients were diabetic, ten were hypertensive and six had prior vascular surgical treatment. The operative arteriograms confirmed vascular occlusive phenomenon. The ankle to brachial ratio was a mean of 0.02. Perioperatively, patients had anticoagulation with heparin systemically. All patients underwent transfemoral embolectomy using a Fogarty catheter. An initial retrieval of clots was accomplished, with documentation by arteriography, instillation of urokinase (50,000 units) and clamping of vessel for 15 minutes. Subsequent passage of the Fogarty catheter and repeat urokinase infusion resulted in further retrieval of clots and improvement by repeat intraoperative arteriography. All interventions resulted in clinical restoration of perfusion to the affected limb. Six patients had amputations of the lower extremities (one transmetatarsal and one below the knee) during the 30 day postoperative period. Improvement in distal run-off was demonstrated by intraoperative arteriography and increases in the ankle to brachial ratio from 0.1 to 1.04, with a mean of 0.54, were noted. No complications from bleeding occurred. One patient died postoperatively because of myocardial infarction. Salvage of the limb may increase with combined embolectomy and thrombolytic therapy.
Garcia
R
R
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Saroyan
R M
RM
Senkowsky
J
J
Smith
F
F
Kerstein
M
M
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D001916:Brachial Artery; D002406:Catheterization, Peripheral / Q000379:methods*; D002408:Catheters, Indwelling; D003131:Combined Modality Therapy; D005069:Evaluation Studies as Topic; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
D014568:Urokinase-Type Plasminogen Activator