Recanalization of chronic peripheral arterial occlusions by alternating intra-arterial rt-PA and PGE1.
BACKGROUND
Recanalization of femoral artery occlusions is difficult and different forms of intra-arterial lysis or mechanical procedures have been described. We investigated the effectiveness of a prolonged intra-arterial lysis with rt-pa in combination with PGE1 followed by angioplasty.


METHODS
43 patients (age 60.4 +/- 14.3 years) with peripheral arterial occlusions older than 3 months and longer than 10 cm were treated with intra-arterial rt-pa (3 mg in 3 h) followed by PGE1 (2.1 ml/h for 3 h, concentration: 20 micrograms/50 ml NaCl) in alternating order. Treatment times ranged from 1 to 7 days (2.9 +/- 1.6). Doses of 26.5 +/- 21.9 mg rt-PA and 20.4 +/- 16 micrograms PGE1 were used. If necessary, angioplasty was performed after a wire was passed through the lumen.


RESULTS
Recanalization was achieved in 47 out of 85 arterial segments with reocclusion in 9 segments. The arterial perfusion deteriorated once due to peripheral embolism. Other adverse effects included one case of retroperitoneal and one case of intracrural bleeding and one aneurysma spurium.


CONCLUSIONS
In chronic arterial occlusions which do not respond to conventional angioplasty and/or short term fibrinolysis recanalization may be achieved in about 50% by means of prolonged alternating application of rt-pa and PGE1.
Kröger
K
K
Klinik und Poliklinik für Angiologie, Universität Essen, Germany.
Hwang
I
I
Rudofsky
G
G
D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage*; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000188:drug therapy*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D010959:Tissue Plasminogen Activator; D000527:Alprostadil