Long-term results of systemic thrombolysis therapy in aorto-iliac occlusive disease.
BACKGROUND
Long term results of systemic lysis therapy with ultrahigh-dose urokinase (UHUK) in reopening aorto-iliac occlusive disease have not yet been evaluated. This prospective trial investigates the long-term primary patency rate, the rate of complications and assesses the role of different expected influence parameters on the primary patency rate.


METHODS
72 patients with aorto-iliac occlusive disease received daily intravenous infusions of UHUK either until reperfusion or--after at least 3 cycles--no progress in recanalization could be stated on two consecutive days by duplex scanning.


RESULTS
Systemic lysis therapy was morphological at least partially successful in 44 patients (61.1%). Concomitant percutaneous transluminal angioplasty was performed in 41 patients (56.9%), surgery in 7 patients (9.7%) and both in further 5 patients (6.9%). In patients without surgery hemodynamical success could be achieved in 39 patients (54.2%) and even more important clinical success in 51 patients (70.8%). Compared to baseline results patients improved significantly in ankle/brachial pressure index and in Fontaine stages (p < 0.001), the same results could be seen after a mean follow-up period of 62 months. Thrombolysis was complicated in 4 patients (5.6%) by macroembolizations but no major bleedings or deaths occurred. Primary patency was 76%, 64%, and 43% after 1, 5 and 10 years. Male sex and distal localization were significantly correlated with lower primary clinical patency.


CONCLUSIONS
Systemic lysis therapy is an alternative to surgical intervention in acute and subacute aorto-iliac occlusive disease, because it offers acceptable long-term results with a low rate of complications.
Bucek
R A
RA
Department of Angiology, University Hospital, Vienna, Austria. robert.bucek@akh-wien.ac.at
Schnürer
G
G
Haumer
M
M
Reiter
M
M
Ahmadi
A
A
Minar
E
E
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000188:drug therapy*; D001157:Arterial Occlusive Diseases / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery; D007262:Infusions, Intravenous; D007511:Ischemia / Q000188:drug therapy; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
D014568:Urokinase-Type Plasminogen Activator