Local thrombolytic infusion in arterial ischemia of the upper limb: mid-term results.
OBJECTIVE
Evaluation of local thrombolytic infusion in arterial ischemia of the upper limbs.


METHODS
Thirteen patients, 4 male and 9 female, aged 31 to 83 (mean 63.6) were treated. The occlusion was determined to be thrombosis in 6 and cardiogenic embolism in 7 patients. Duration of symptoms varied from 2 hours to 3 weeks. Streptokinase (SK) was used in 4 patients at a rate of 5,000 units per hour, Urokinase (UK) in 8 patients at a rate of 75,000 units per hour and r-tPA in 1 patient at a rate of 4 mg per hour for 5 hours. Mean duration of infusion was 16 hours (3-39 hr) for SK and 35 hours (10-93 hr) for UK. Heparin was administered concommitantly at a rate of 300 to 1000 units per hour without a loading dose.


RESULTS
Clinical limb salvage was obtained in all patients. Angiography showed complete clot dissolution and full clinical recovery in 8 patients. Five patients had partial clot clearing, 3 with full recovery and 2 with modest residual symptoms. One patient incurred a catheter-related transient cerebral ischemia, 1 patient a large arm hematoma from catheter-related trauma and 6 patients a moderate puncture site hematoma. Three patients died during the first month due to stroke, ventricular fibrillation, or cardiac failure, and 1 patient after 22 months from cardiac failure. No limb ischemia recurred during a follow-up of 1 to 5 years.


CONCLUSIONS
Local thrombolytic infusion is a safe and effective treatment for acute and subacute upper extremity arterial thromboembolism.
Coulon
M
M
Department of Medical Imaging, University Hospital Sart Tilman, Liège, Belgium.
Goffette
P
P
Dondelinger
R F
RF
D001132:Arm / Q000098:blood supply*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013300:Streptokinase / Q000008:administration & dosage* / Q000627:therapeutic use; D013923:Thromboembolism / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator