Thrombolysis versus surgery as the initial management for native artery occlusion: efficacy, safety, and cost.
BACKGROUND
A controversy has evolved as to which therapy, thrombolysis or thromboembolectomy, represents the optimal initial treatment for acute native artery occlusion.


METHODS
Forty-eight cases of acute class I or II limb ischemia caused by native artery occlusion were retrospectively analyzed between 1988 and 1993. Nineteen of the patients were initially treated with thrombolysis (group 1), and 29 underwent thromboembolectomy (group 2).


RESULTS
Initial clinical improvement was seen in 11 (57.9%) of 19 extremities in group 1, with complete clot resolution in 21%, partial lysis in 47.4%, and no angiographic improvement in 31.6%. Significantly superior results were achieved in group 2; 28 (97%) of 29 limbs showed clinical improvement after initial surgical therapy (p = 0.001). Limb salvage was 88.2% in group 1 and 96.6% in group 2 (p = 0.5). Adjunctive procedures for limb salvage were necessary in 10 (52.6%) of 19 limbs in group 1 compared with only five (17.2%) of 29 limbs in group 2 (p = 0.013). Perioperative mortality was 10.5% and 10.3% (p = 1.0), whereas major postoperative complications occurred in 63.2% and 37% of patients in groups 1 and 2, respectively (p = 0.14). Hospital and professional patient charges were analyzed for the 12 most recent patients from each group. Total mean charges per patient were higher in group 1 ($45,171) than in group 2 ($24,898) (p = 0.046).


CONCLUSIONS
Patients initially treated surgically achieved better immediate clinical results with significant cost savings and without significant differences in morbidity, mortality, or limb salvage compared with patients treated initially by thrombolysis.
Hoch
J R
JR
Department of Surgery, University of Wisconsin, Madison.
Tullis
M J
MJ
Acher
C W
CW
Heisey
D M
DM
Crummy
A B
AB
McDermott
J C
JC
Wojtowycz
M
M
Sproat
I A
IA
Turnipseed
W D
WD
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D017128:Embolectomy / Q000009:adverse effects / Q000191:economics; D005121:Extremities / Q000098:blood supply; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017131:Thrombectomy / Q000009:adverse effects / Q000191:economics; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics