title: The impact of thrombolytic therapy on arterial and graft occlusions: a critical analysis.
abstract: BACKGROUND
  The indications for intraarterial thrombolytic therapy of lower extremity native arterial and synthetic graft occlusions prior to vascular reconstructions requires further refinement before firm conclusions can be made.
  
  
  METHODS
  A retrospective review of 55 patients undergoing 81 lytic treatments with high dose urokinase from February 1989 to February 1993 was performed. The cases were divided into three groups: Group I: successful thrombolysis with residual defects followed by surgical reconstruction or percutaneous transluminal angioplasty (PTA); Group II: successful thrombolysis alone; and Group III: failure of thrombolysis requiring reconstruction or leading to amputation. No effort was made to analyze the particular type of reconstruction. Follow-up ranged from 1 to 1627 days (4 years and 5 1/2 months).
  
  
  RESULTS
  One, two, and three year patency rates were 47%, 24%, and 8% for Group I; 57%, 46%, and 46% for Group II; and 24%, 10%, and 10% for Group III respectively. The one, two and three year limb salvage rates were 92%, 76%, and 76% for Group I; 82%, 82%, and 82% for Group II; and 48%, 37%, and 37% for Group III respectively. Forty-one complications occurred in 35 of the 81 (43%) lytic treatments.
  
  
  CONCLUSIONS
  Intraarterial thrombolytic therapy can be regarded as a possible consideration in the initial management of acute lower extremity arterial and synthetic graft occlusions especially in patients with multiple prior vascular reconstructions. Unsuccessful thrombolysis results in a poor outcome despite surgical reconstruction in the majority of cases.
authors.affiliation: Department of Surgery, Hahnemann University School of Medicine, Phildelphia, PA, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Bhatnagar
authors.forename: R P
authors.initials: RP
authors.lastname: Ierardi
authors.forename: Y
authors.initials: Y
authors.lastname: Ikeda
authors.forename: H
authors.initials: H
authors.lastname: Wada
authors.forename: A
authors.initials: A
authors.lastname: Wilson
authors.forename: P
authors.initials: P
authors.lastname: Khoury
authors.forename: C
authors.initials: C
authors.lastname: Karamonte
authors.forename: M
authors.initials: M
authors.lastname: Kerstein
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007261:Infusions, Intra-Arterial; D007866:Leg / Q000098:blood supply; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014654:Vascular Patency
chemical_list: D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator