Local thrombolysis in the treatment of thrombosed arteries, bypass grafts, and arteriovenous fistulas.
We reviewed the results, systemic effects, and complications associated with the selective infusion of low-dose streptokinase in 151 patients. Successful thrombus lysis was achieved in 78% of atherosclerotic thrombotic occlusions less than 30 days old, in 81% of post-procedural occlusions less than 14 days old, and in 87% of patients with thrombosed arteriovenous fistulas no more than 4 days old. During the first 12 hours of treatment 81% to 84% of patients had greater than 50% decrease in plasma fibrinogen levels and 100% showed the same decline after 24 hours of treatment. The thrombin time was prolonged to at least 1 1/2 times the control thrombin time in 33% to 42% of patients measured at 4 hours of therapy and in 93% to 97% of patients measured at 24 hours of treatment. Fifteen patients (9.9%) had major complications. Eleven of these had hemorrhagic complications, two had significant distal emboli, one had a thrombosed brachial artery, and one had a false aneurysm at the catheter entry site. We have found that selective low-dose streptokinase is effective in the treatment of acute and chronic thrombotic occlusions and is a useful adjuvant to vascular reconstruction or percutaneous transluminal angioplasty. Although the local infusion dose is substantially lower than the usual systemic dose, a systemic lytic effect was seen in all patients. Hemorrhagic complications occurred despite customary precautions.
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D001161:Arteriosclerosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D001164:Arteriovenous Fistula / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D005342:Fibrinolysis; D006083:Graft Occlusion, Vascular / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects; D007263:Infusions, Parenteral / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D013300:Streptokinase / Q000627:therapeutic use*; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*
D011138:Polytetrafluoroethylene; D013300:Streptokinase