The value of preoperative lytic therapy in limb-threatening acute ischemia from popliteal artery aneurysm.
In a retrospective study, we analyzed our experiences in 24 patients with acute ischemia from popliteal artery aneurysms over a period of 27 years and evaluated the value of a preoperative lytic therapy as an adjunct to surgical revascularization, compared to surgery alone. Preoperative urokinase therapy revealed a satisfactory improvement of the runoff in all cases. Follow-up angiography showed complete lysis in 6 and incomplete lysis in 3 of 9 patients. In contrast, in patients treated by surgery alone, postoperative angiography showed residual clots in all cases. The overall amputation rate was 25% (6/24) in 24 popliteal aneurysms with acute ischemia, including four patients with primary amputation for irreversible gangrene. Bypass grafting alone resulted in an early amputation rate of 9% (1/11) and occlusive complications of 45% (5/11) compared to no limb loss and no bypass complication in patients who underwent combined surgery and preoperative lysis (0/9). Our results underline the value of preoperative lytic therapy as an important factor in the management of acute ischemia in popliteal artery aneurysms.
Hoelting
T
T
Department of Surgery, University of Heidelberg, Germany.
Paetz
B
B
Richter
G M
GM
Allenberg
J R
JR
D000208:Acute Disease; D000368:Aged; D000671:Amputation, Surgical; D000783:Aneurysm / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000188:drug therapy* / Q000209:etiology; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D014568:Urokinase-Type Plasminogen Activator