title: Intraoperative intra-arterial urokinase therapy after failed embolectomy in acute lower limb ischemia.
abstract: BACKGROUND
  Aim of this study is to evaluate the use of intraoperative intra-arterial urokinase infusion (IIUI) in overcoming residual thrombi after thromboembolectomy in acute lower limb ischemia.
  
  
  METHODS
  
  
  
  METHODS
  retrospective study over a 3-year period.
  
  
  METHODS
  University affiliated hospital.
  
  
  METHODS
  21 patients with acute lower limb ischemia who underwent IIUI after embolectomy (18 transfemoral, 3 transpopliteal) had failed to achieve adequate distal perfusion. Postoperatively, all patients were maintained on full dose heparinization.
  
  
  METHODS
  complete or partial clot lysis on post-IIUI angiography; restoration of pedal pulses and a viable leg at discharge.
  
  
  RESULTS
  Angiographically, complete and partial lysis was demonstrated in 14 and 3 patients, respectively. Two patients with prolonged ischemia required fasciotomy. One of these eventually had an amputation. Altogether, limb amputations (1 above knee, 2 below knee) were necessary in 3 patients. The angiographic appearance of lysis correlated well with the restoration of pedal pulses and/or limb viability. One patient died of myocardial infarction 3 days after the procedure. Postoperatively, there were 5 (24%) wound hematomas of which 1 required surgical exploration. Over a mean follow-up period of 8 months (range 1-16), limb salvage was sustained in the 17 patients with successful angiographic lysis.
  
  
  CONCLUSIONS
  IIUI is an effective therapeutic adjunct to failed embolectomy in acute lower limb ischemia. Use of this procedure is recommended as part of the routine management in such cases.
authors.affiliation: Vascular Surgery Unit, Meir General Hospital, Tel-Aviv University Sackler School of Medicine, Kfar Saba, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Witz
authors.forename: Z
authors.initials: Z
authors.lastname: Korzets
authors.forename: M
authors.initials: M
authors.lastname: Ellis
authors.forename: A
authors.initials: A
authors.lastname: Shnaker
authors.forename: J
authors.initials: J
authors.lastname: Lehmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D017128:Embolectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D007430:Intraoperative Care / Q000379:methods; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014654:Vascular Patency
chemical_list: D014568:Urokinase-Type Plasminogen Activator