title: Thrombolysis or operation for peripheral arterial occlusion.
abstract: Patients with peripheral arterial occlusion may be treated with one of three distinct treatment strategies: observation and/or anticoagulation alone, operative intervention, or catheter-directed thrombolytic therapy. The severity of symptoms is the most important clinical parameter with which to formulate clinical strategies. Patients with non-lifestyle limiting claudication may be best managed without arteriographic investigation, managing symptoms conservatively with exercise, cessation of smoking, and occasionally the oral pharmacologic agent pentoxifylline. Patients with threatened limbs in the form of rest pain or tissue loss carry a high risk of limb loss without intervention. These patients should undergo arteriography with consideration of endovascular intervention for focal lesions and bypass grafting for more diffuse disease. Patients with more acute symptoms may be best treated with catheter-directed thrombolytic therapy, addressing unmasked lesions responsible for the occlusion with an operative or endovascular approach. In all cases, the appropriate therapy must be tailored to the clinical presentation, the anatomic distribution of disease, and the experience of the clinical team.
authors.affiliation: Department of Surgery, University of Rochester, NY 14642, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ouriel
mesh_terms: D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017321:Clinical Trials, Phase I as Topic; D006801:Humans; D015337:Multicenter Studies as Topic; D009518:New York; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D014568:Urokinase-Type Plasminogen Activator