[Catheter-guided thrombolysis in peripheral arterial occlusion].
By catheter-directed, regional, intravascular thrombolysis a thrombus-dissolving enzyme is applied through a catheter placed at/in the occlusion. Non-fibrin-specific (streptokinase or urokinase) and fibrin-specific agents (tissue plasminogen activators) are available. The large randomised trials (TOPAS and STILE) have serious selection bias, which makes generalisation difficult. Other studies have incomparable data and thus meta-analysis is impossible. Consequently, a recent consensus document cannot recommend an agent or principle of infusion. Thrombolysis of late, but transitory (< 14 days), occlusions seems beneficial but long-term results are lacking and recurrences are common. Exclusion of preoperative thrombolysis in late and longer lasting occlusions (> 14 days) is debatable, because of a potential thrombolysis-caused improved run-off. Individual case selection is still needed, because thrombolysis is a promising, although experimental, treatment.
Lindholt
J S
JS
Viborg Sygehus, organkirurgisk afdeling, karkirurgisk afsnit, og billeddiagnostisk afdeling. jslindholt@mail.tele.dk
Holt
G
G
Sandermann
J
J
D001157:Arterial Occlusive Diseases / Q000188:drug therapy* / Q000601:surgery; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D000075202:Contraindications; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007511:Ischemia / Q000188:drug therapy / Q000601:surgery; D007866:Leg / Q000098:blood supply; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000188:drug therapy / Q000601:surgery; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator
Katetervejledt trombolyse ved perifer arteriel okklusion.