Thrombolytic treatment and balloon angioplasty in chronic occlusion of the aortic bifurcation.
OBJECTIVE
To evaluate nonsurgical alternatives in reopening chronically occluded aortic bifurcation.


METHODS
Uncontrolled randomized study.


METHODS
University-affiliated referral center for vascular diseases.


METHODS
Twenty-five of 39 consecutive patients with chronic aortoiliac disease including a totally occluded aortic bifurcation were found to be acceptable candidates for an aortobifemoral prosthetic graft.


METHODS
Patients were randomly assigned to receive either streptokinase or urokinase or recombinant tissue-type plasminogen activator (rt-PA). In cases of successful thrombolysis and residual obstructions, subsequent balloon angioplasty was attempted. Prosthetic bypass grafting was done if thrombolytic treatment and balloon angioplasty failed.


RESULTS
Complete lysis was achieved in 5 of 25 patients (20%). In 10 (40%) patients, lysis showed residual obstructions, which were reopened mechanically in 8 patients; 2 patients had extra-anatomical bypass grafts. Ten patients (40%) without thrombolysis had surgical aortobifemoral bypass grafts. Overall, recanalization and clinical improvement were achieved in 13 of 25 patients (52%) by thrombolytic therapy and subsequent balloon angioplasty. The recanalization rate did not differ among the different thrombolytic drugs. However, rt-PA therapy resulted in reopening after 4 days of treatment; streptokinase, after 6 days; and urokinase, after 9 days (P < 0.005). No major complications or deaths occurred.


CONCLUSIONS
Thrombolytic treatment followed by balloon angioplasty may help avoid the need for aorto-bifemoral prosthetic bypass grafting in more than 50% of patients with chronic aortoiliac disease.
Pilger
E
E
Department of Internal Medicine, Karl-Franzens-University, Graz, Austria.
Decrinis
M
M
Stark
G
G
Koch
G
G
Obernosterer
A
A
Tischler
R
R
Lafer
M
M
Doder
A
A
D000328:Adult; D000800:Angioplasty, Balloon; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000188:drug therapy / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000628:therapy*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011897:Random Allocation; D011994:Recombinant Proteins / Q000627:therapeutic use; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D011994:Recombinant Proteins; D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator