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Thrombolysis in arterial occlusion.
1Center for Molecular and Vascular Biology, University of Leuven, Belgium. raymond.verhaeghe@uz.kuleuven.ac.be
Thrombosis and Haemostasis
|March 1, 2000
Summary
Intra-arterial thrombolysis is now standard for limb arterial occlusion, often using urokinase or alteplase. While effective, severe bleeding, including stroke risk (1-2%), remains a concern.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Pharmacology
Background:
- Intra-arterial thrombolysis has largely superseded systemic intravenous infusion for treating limb arterial occlusion.
- Various catheter-guided techniques and infusion protocols have been developed.
Purpose of the Study:
- To review the current status of intra-arterial thrombolytic therapy for limb arterial occlusion.
- To compare thrombolysis with surgical intervention and discuss complications.
Main Methods:
- Review of existing literature comparing intra-arterial thrombolysis with surgical interventions.
- Analysis of clinical practice regarding preferred thrombolytic agents (urokinase, alteplase).
- Assessment of complication rates, particularly severe bleeding and hemorrhagic stroke.
Main Results:
- No definitive proof of superiority for any specific thrombolytic agent regarding efficacy or safety.
- Clinical practice favors urokinase or alteplase.
- Thrombolytic therapy is considered appropriate initial management for acute leg artery or bypass graft occlusion.
- Underlying lesions are subsequently treated with endovascular or surgical methods.
- Severe bleeding is the primary concern, with a 1-2% risk of hemorrhagic stroke.
Conclusions:
- Intra-arterial thrombolysis is a valuable treatment for limb arterial occlusion, often preceding definitive lesion repair.
- Urokinase and alteplase are commonly used agents, though superiority is unproven.
- Risk of severe bleeding, including hemorrhagic stroke, necessitates careful patient selection and monitoring.