[Fibrinolytic, revascularizing therapy of peripheral arterial occlusive disease]

Thrombo-embolic events are the primary or secondary cause for occlusions of peripheral arteries. The systemically applied fibrinolysis rarely resulted in revascularization. The local application of plasminogen activators leads to better results. Combined with interventionally techniques 70-80% of the acute und subacute occlusions can be opened an the necessity of angio-surgical interventions can be reduced by about 50%. The technical procedure of the local fibrinolysis and the dosages of the applied activators are presently not standardized. Therefore the results of 13 reports between the years 1995-1998 including 4 prospective studies are not comparable. According to the present experiences, acute und subacute incomplete ischemia syndromes are to be seen as indication for local lysis. Especially for patients whose constitution is not optimal for surgery, local fibrinolysis is an alternative to surgical revascularization. Further studies are necessary to optimize the therapy.