Endovascular techniques for abdominal aortic occlusions.
The application of endovascular interventions is spreading to encompass more anatomic locations and a wider array of vascular pathologies. The combination of thrombolysis with intraluminal devices has been an important factor in applying interventional therapy to abdominal aortic occlusive disease, where such intraluminal options can reduce the need for abdominal surgery. Seven patients with total abdominal aortic occlusions were treated with antegrade, high-dose urokinase infusion delivered to the clot site over a 20-48 hour period prior to balloon dilation and Palmaz stent implantation for unresolved pressure gradients, residual plaque, lesion recoil, or dissection. Lytic therapy cleared the thrombus totally in 6 patients and sufficiently in the 7th to facilitate retrograde iliac artery wire passage. All 7 patients required stent implantation to maximize revascularization (11 stents deployed in the abdominal aorta and 10 in the common iliac arteries). There were 2 instances of post-procedural distal embolization attributable to the thrombolysis, but both were treated satisfactorily. In up to 28 months of follow-up, all patients remain asymptomatic. Combining lytic therapy and stenting extends the applicability of endovascular interventions to patients with aortic occlusion.
Diethrich
E B
EB
Department of Cardiovascular Surgery, Arizona Heart Institute and Foundation, Phoenix.
D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D015912:Thrombolytic Therapy / Q000295:instrumentation; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D014568:Urokinase-Type Plasminogen Activator