title: Thrombolytic treatment and balloon angioplasty in chronic occlusion of the aortic bifurcation.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Karl-Franzens-University, Graz, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Pilger
authors.forename: M
authors.initials: M
authors.lastname: Decrinis
authors.forename: G
authors.initials: G
authors.lastname: Stark
authors.forename: G
authors.initials: G
authors.lastname: Koch
authors.forename: A
authors.initials: A
authors.lastname: Obernosterer
authors.forename: R
authors.initials: R
authors.lastname: Tischler
authors.forename: M
authors.initials: M
authors.lastname: Lafer
authors.forename: A
authors.initials: A
authors.lastname: Doder
mesh_terms: 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
chemical_list: D011994:Recombinant Proteins; D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator