title: Urokinase thrombolysis in acute-on-chronic vascular occlusion of lower limb.
abstract: Between January 2000 and June 2003, 70 patients (63 men and 7 women) with acute-on-chronic lower limb vascular occlusion underwent thrombolysis with 1 million units of urokinase. Forty-eight patients had unilateral and 22 had bilateral involvement; 9 had gangrenous changes. The mean age was 47 +/- 9 years, 73% were smokers, and 13% had diabetes. The definition of a good response was either return of distal pulses or a warm limb and relief of pain at rest. Fifty-three (76%) patients (including 5 with gangrenous changes) had symptomatic improvement with thrombolysis (group 1), and 17 (24%) did not respond (group 2). All 70 patients (including 7 who later required amputation) underwent surgical intervention with a polytetrafluoroethylene interposition graft or arterioplasty. A good response to surgical treatment was found in significantly more patients (49/53, 92%) in group 1 compared to group 2 (7/17, 41%). Claudication distance after 6 months of follow-up improved in a significantly higher percentage of patients in group 1 (85%) than group 2 (38%). Preoperative thrombolysis improved the outcome and predicted the result of arterial surgery.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, SMS Medical College & Hospital, H-16, Chitranjan Marg, C-Scheme, Jaipur-302001, Rajasthan, India. cps_sms@hotmail.com
authors.forename: Chandra P
authors.initials: CP
authors.lastname: Shrivastava
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Devgarha
mesh_terms: D000208:Acute Disease; D000328:Adult; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007383:Intermittent Claudication / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014656:Vascular Surgical Procedures / Q000295:instrumentation
chemical_list: D005343:Fibrinolytic Agents; D011138:Polytetrafluoroethylene; D014568:Urokinase-Type Plasminogen Activator