The impact of thrombolytic therapy on arterial and graft occlusions: a critical analysis.
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.
Bhatnagar
P K
PK
Department of Surgery, Hahnemann University School of Medicine, Phildelphia, PA, USA.
Ierardi
R P
RP
Ikeda
Y
Y
Wada
H
H
Wilson
A
A
Khoury
P
P
Karamonte
C
C
Kerstein
M
M
Matsumoto
T
T
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
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator