title: Acute arterial occlusions of the small vessels of the hand and forearm: treatment with regional urokinase therapy.
abstract: OBJECTIVE
  Arterial occlusions of the small vessels of the forearm and hand may have the same consequences as arterial occlusions in the distal lower extremity. There is limited reported experience with the regional thrombolytic therapy in this setting. The authors reviewed their experience with thrombolytic therapy in acute and subacute arterial occlusions of the distal upper extremity to further clarify its role.
  
  
  METHODS
  Twelve patients with acute or subacute arterial occlusions of the forearm and hand who had ischemic digits and were treated with regional urokinase infusion were identified retrospectively. Their medical and radiology records were reviewed.
  
  
  RESULTS
  All 12 patients demonstrated angiographic improvement and 11 patients demonstrated clinical improvement after treatment. Tissue necrosis in four patients led to partial amputation of one digit in two patients and three digits in two patients. Three of these patients had category III ischemia at presentation. The level of resulting amputation was altered in all but one patient. Vasospasm was noted frequently but responded to vasodilators. No significant complications occurred.
  
  
  CONCLUSIONS
  When therapeutic alternatives are limited to anticoagulation and expectant amputation, regional urokinase infusion can optimize distal runoff, obviate or improve the options for distal surgical bypass, and limit tissue loss.
authors.affiliation: Department of Radiology, University of Colorado Health Sciences Center, Denver 80262, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Johnson
authors.forename: J D
authors.initials: JD
authors.lastname: Durham
authors.forename: S W
authors.initials: SW
authors.lastname: Subber
authors.forename: M
authors.initials: M
authors.lastname: Gordon
authors.forename: R
authors.initials: R
authors.lastname: Rutherford
authors.forename: C
authors.initials: C
authors.lastname: Law
authors.forename: J
authors.initials: J
authors.lastname: Krysl
authors.forename: D A
authors.initials: DA
authors.lastname: Kumpe
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D014568:Urokinase-Type Plasminogen Activator