Lower limb intraarterial thrombolysis as an adjunct to the management of arterial and graft occlusions.
Intraarterial thrombolysis is used increasingly for management of arterial and bypass graft occlusions. Current research has been directed at the indications for and methods of catheter-directed thrombolysis. Streptokinase, urokinase, and tissue plasminogen activator (t-PA) are the most commonly used agents. They are administered by a variety of techniques and in various doses involving intrathrombic infusions, thrombus lacing, high-dose bolus therapy, and pulse-spray lysis. The latter methods appear to produce thrombolysis within a few hours, so this chemical therapy has the potential to become the first-line management for all episodes of acute limb ischemia. The role of thrombolysis is to return patients to their prethrombotic or preembolic state, so the underlying condition can be treated by radiologic intervention, surgery, or anticoagulation. Intraarterial thrombolysis is indicated for occlusions of less than 2 weeks' duration where the limb is able to withstand a period of further ischemia. Older occlusions should be treated by surgery, reserving intraoperative lysis for specific situations.
Braithwaite
B D
BD
Department of Surgery, Section of Vascular Surgery, UCLA Center for the Health Sciences, UCLA Medical Center, 10833 Le Conte Avenue, 72-167 CHS, Los Angeles, California 90024-6904, U.S.A.
Quiñones-Baldrich
W J
WJ
D000792:Angiography; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007511:Ischemia / Q000188:drug therapy*; D007866:Leg / Q000098:blood supply*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*