When is urokinase treatment an effective sole or adjunctive treatment for acute limb ischemia secondary to native artery occlusion?
BACKGROUND
Intra-arterial thrombolytic therapy is currently a therapeutic option for the treatment of acute limb ischemia. A recent large prospective randomized trial (TOPAS) comparing lytic therapy and operative intervention showed that both forms of treatment had similar results in terms of amputation-free survival. However, the exact role for lytic treatment is unclear.


METHODS
Over a 4-year period we treated 60 cases of acute limb ischemia in 57 patients secondary to native artery occlusion with thrombolytic therapy with urokinase. All patients were evaluated at 1 week, 1 month, and then at 3-month intervals posttreatment. Follow-up evaluations included pulse examination, pulse volume recordings, and duplex examinations to confirm arterial patency. No patients were lost to follow-up with a range of 8 to 54 months (mean 26).


RESULTS
Of these 60 native arterial occlusions, complete lysis was achieved in 46 cases (76%). Of these 46 cases, 18 required lysis only, 19 cases (9 iliac, 7 superficial femoral artery (SFA), and 3 popliteal) required angioplasty of lesions uncovered by clot lysis, and 9 patients had lysis and angioplasty of iliac arteries followed by infrainguinal bypasses. Eight of the 57 patients (14%) who had been asymptomatic presented with symptoms limited to new onset claudication, all of which were successfully lysed. Cumulative patency for the 43 successful cases was 90% +/- 5% at 1 year and 75% +/- 4% at 2 years. The 1-year amputation-free survival for all native artery occlusions was 85% +/- 6%.


CONCLUSIONS
Thrombolysis with urokinase simplified the treatment of native arterial occlusion proving to be the sole therapy in 18 (29%) patients or a valuable adjunct by facilitating the angioplasty of arterial lesions and avoiding open surgery in 60% of patients treated. In addition, the correction of inflow lesions reduced the magnitude of required subsequent bypass procedures to achieve limb salvage. In conclusion, successful thrombolysis of native artery occlusion provided durable arterial patency and limb salvage, particularly in patients with new onset claudication.
Suggs
W D
WD
Division of Vascular Surgery, Montefiore Medical Center, New York, New York 10467, USA.
Cynamon
J
J
Martin
B
B
Sanchez
L A
LA
Wahl
S I
SI
Aronoff
B
B
Veith
F J
FJ
D000208:Acute Disease; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D001810:Blood Volume / Q000502:physiology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D007269:Injections, Intra-Arterial; D007383:Intermittent Claudication / Q000188:drug therapy; D007511:Ischemia / Q000188:drug therapy* / Q000209:etiology; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011674:Pulse; D015912:Thrombolytic Therapy; D018616:Ultrasonography, Doppler, Duplex; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014654:Vascular Patency
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator