title: [Regional hyperthermic fibrinolytic perfusion as ultima ratio in critical ischemia of the lower extremities].
abstract: In 19 patients (male-female: ratio 10:9; median age 67.1 (42-90) years) with a critical ischaemia of the lower extremities either after failed attempt of revascularization (n = 4) or because of lacking possibility for vessel reconstruction measures (n = 16) a regional extremity perfusion with a fibrinolytic agent has been performed using a heart lung machine. In one patient both lower extremities were treated. In the first 30 minutes of the total 60 minutes perfusion time on average 31 mg (20-50 mg) of recombinant tissue-plasminogen activator (Actilyse) have been added to the perfusion solution. In order to enhance the fibrinolysis-activity the perfusion solution was warmed up to 40 degrees C. Systemic side effects have not been observed. Two patients died postoperatively because of their underlying diseases (mesenteric artery embolism, myocardial infarction), two patients experienced postoperative haemorrhage and one patient had a wound infection. In 11 cases (55%) an opening of the stem-arteries has been reached. Seven of these were successfully revascularized with a femoro-crural bypass in a following operation. Nine extremities (45%) remained without opening of the stem-arteries, however, in four cases (20%) an improved radiographic contrast of the collaterals has been reached. 11 (61%) of the followed-up extremities were successfully revascularized. Amputation has been performed in seven cases (39%). The regional hyperthermic perfusion with fibrinolytic drugs enables a reopening of the stem-arteries and the creation of accepting vessels for vascular procedures in primarily inoperable arterial occlusions.
authors.affiliation: Klinik für Herz-, Thorax- und Gefässchirurgie, St. Johannes- Hospital, Dortmund.
authors.forename: A
authors.initials: A
authors.lastname: Mumme
authors.forename: W
authors.initials: W
authors.lastname: Maatz
authors.forename: G
authors.initials: G
authors.lastname: Walterbusch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003131:Combined Modality Therapy; D005260:Female; D006355:Heart-Lung Machine; D006801:Humans; D006979:Hyperthermia, Induced / Q000295:instrumentation*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000295:instrumentation*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D010959:Tissue Plasminogen Activator
vernacular_title: Regionale hypertherme Fibrinolytika-Perfusion als ultima ratio bei kritischer Ischämie der unteren Extremitäten.