Use of thrombolytics in vascular and endovascular surgery.
Until recently, acute arterial or venous thromboses were routinely managed with surgical intervention. With the development of effective thrombolytic pharmacologic agents and improved modes of delivery of these agents to the target site, surgery is no longer the only option. Greater understanding and knowledge about the finely orchestrated, counterbalanced processes of coagulation and fibrinolysis/thrombolysis have enabled development of agents and strategies for pharmacologic restoration of vascular patency while reducing or eliminating the need for surgery. An evidence-based rationale now exists for the use of thrombolysis in acute limb ischemia, deep venous thrombosis, stroke, and arteriovenous vascular access thromboses. Thrombolytic agents are valuable ancillary agents that allow a less invasive solution to a variety of thrombotic vascular conditions. Strategies that combine thrombolytic agents with endovascular techniques provide precise delivery of these drugs to the target thrombus. A more widespread adoption of this strategy has been limited primarily owing to problems with the currently available pharmacologic agents. The future of thrombolysis therapy is discussed in terms of data obtained from ongoing and recently completed clinical trials. Efforts to develop and study new thrombolytic agents that act directly on the thrombus without activation of intermediary biochemical steps will provide the next major step forward, as well as the rational basis for expansion of currently accepted indications for the treatment of acute arterial and venous thromboses.
Weaver
Fred A
FA
University of Southern California, Cardio Vascular Thoracic Institute, Section of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, Los Angeles, CA, USA. fweaver@surgery.usc.edu
Lew
Wesley K
WK
D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000628:therapy; D006801:Humans; D020767:Intracranial Thrombosis / Q000628:therapy; D019060:Minimally Invasive Surgical Procedures; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013927:Thrombosis / Q000628:therapy*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000628:therapy
D005343:Fibrinolytic Agents