Acute peripheral arterial occlusion: predictors of success in catheter-directed thrombolytic therapy.
OBJECTIVE
To determine predictors of clot dissolution in patients undergoing catheter-directed urokinase thrombolysis for peripheral arterial occlusion (PAO).


METHODS
The study included 103 patients with limb-threatening symptoms of embolism lasting 14 days or less and resulting from embolism (n = 20) or thrombosis (n = 83). Successful lysis was defined as restitution of antegrade flow with less than 20% diameter reduction by residual thrombus. Stepwise logistic regression was used to analyze the data.


RESULTS
Relevant clinical variables were diabetic status (odds ratio, 0.75; P = .04 for diabetic patients), conduit type (1.25; P = .04 for native artery and 1.51; P = .02 for prosthetic graft), and number of arterial segments involved (1.60; P = .02 for one level and 1.42; P = .03 for two levels). Important procedural variables included intrathrombus positioning of catheter ports (odds ratio, 7.40; P = .001) and guide wire passage through the occlusion (3.10; P = .003). Absolute thrombus volume was nonpredictive but correlated with reperfusion time (P = .02) and infusion time (P = .01).


CONCLUSIONS
Predictive parameters may help in the selection of candidates with PAO for thrombolytic therapy.
Ouriel
K
K
Department of Surgery, University of Rochester School of Medicine and Dentistry, NY 14642-8410.
Shortell
C K
CK
Azodo
M V
MV
Guiterrez
O H
OH
Marder
V J
VJ
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral; D004617:Embolism / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000188:drug therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D014568:Urokinase-Type Plasminogen Activator