Failure of thrombolytic therapy to improve long-term vascular patency.
OBJECTIVE
Few data are available on long-term follow-up of arterial segments subjected to thrombolysis. We reviewed all cases of vascular occlusion treated with urokinase to identify early success and determine the influence of postlysis intervention and the nature of the thrombosed segment (i.e., artery vs graft) on long-term patency.


METHODS
Data on 134 cases (58 arteries, 76 grafts) treated with high-dose urokinase infusion in the lower limbs over a 7-year period were analyzed. Limbs were divided into five groups on the basis of therapy after lytic infusion to determine long-term efficacy: group I, success with no additional therapy; group II, percutaneous angioplasty alone; group III, limited surgical procedure (operative angioplasty, jump graft); group IV, extensive procedure (new bypass); and group V, revascularization after lytic failure. Long-term results were assessed by life-table analysis and groups compared by log-rank test (Mantel-Haenszel).


RESULTS
Initial patency was established in 87 (64.9%) of 134 cases with 5 deaths (3.7%), 11 amputations (8.2%), and 16 complications (11.9%). Follow-up was available in 68.6% of cases for a mean of 10.9 months. No difference was seen between grafts and native arteries. Patency was analyzed at 6, 12, 18, and 24 months. The 24-month patency rate after lysis alone (group I-25.9%) was inferior (p < 0.05) to results after lysis and any subsequent intervention (groups II, III, and IV). The type of intervention did not influence subsequent patency. Twenty-four-month patency of procedures performed after failed thrombolysis (group V, 41.4%) was not different from those after successful lysis (groups I to IV). Twenty-four-month patency in groups II and III (minor interventions, 62.9%) was not significantly different from that of groups IV and V (major interventions, 53.2%) (p > 0.25).


CONCLUSIONS
Operative intervention is required to produce long-term arterial patency, even after successful thrombolysis. No statistically significant benefit of thrombolysis on vascular patency was seen in our series.
Faggioli
G L
GL
Department of Surgery, State University of New York at Buffalo.
Peer
R M
RM
Pedrini
L
L
Di Paola
M D
MD
Upson
J A
JA
D'Addato
M
M
Ricotta
J J
JJ
D017130:Angioplasty; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000401:mortality / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D015912:Thrombolytic Therapy / Q000379:methods*; D017211:Treatment Failure; D014568:Urokinase-Type Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D014654:Vascular Patency / Q000187:drug effects*
D014568:Urokinase-Type Plasminogen Activator