Intraoperative thrombolysis in peripheral arterial occlusion.
Thromboembolic occlusion of peripheral arteries continues to be associated with significant morbidity, mortality and loss of limbs. Surgical intervention with prompt revascularization by clot extraction, alone or in combination with arterial bypass, remains the standard therapy for critical ischemia with imminent tissue loss. Mechanical thrombectomy using a balloon catheter has been the preferred technique for distal embolus or thrombus extraction. Unfortunately, complete thrombectomy is rare, and the procedure is associated with arterial wall injury. Intraoperative thrombolytic therapy is an attractive adjunct to catheter thrombectomy alone and is appropriate in the care of a significant number of patients with acute limb ischemia. Its safety and efficacy have been confirmed in the laboratory and in a limited number of patients. The authors review experimental and clinical data and report their experience with 19 patients.
Wasselle
J A
JA
Department of Surgery, University of South Florida College of Medicine, Tampa.
Bandyk
D F
DF
D000208:Acute Disease; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000792:Angiography; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D004341:Drug Evaluation; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology; D011379:Prognosis; D013300:Streptokinase / Q000494:pharmacology / Q000627:therapeutic use*; D017131:Thrombectomy; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*
D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator