Long-term results of systemic thrombolysis therapy in aorto-iliac occlusive disease

Long term results of systemic lysis therapy with ultrahigh-dose urokinase (UHUK) in reopening aorto-iliac occlusive disease have not yet been evaluated. This prospective trial investigates the long-term primary patency rate, the rate of complications and assesses the role of different expected influence parameters on the primary patency rate.

72 patients with aorto-iliac occlusive disease received daily intravenous infusions of UHUK either until reperfusion or--after at least 3 cycles--no progress in recanalization could be stated on two consecutive days by duplex scanning.

Systemic lysis therapy was morphological at least partially successful in 44 patients (61.1%). Concomitant percutaneous transluminal angioplasty was performed in 41 patients (56.9%), surgery in 7 patients (9.7%) and both in further 5 patients (6.9%). In patients without surgery hemodynamical success could be achieved in 39 patients (54.2%) and even more important clinical success in 51 patients (70.8%). Compared to baseline results patients improved significantly in ankle/brachial pressure index and in Fontaine stages (p < 0.001), the same results could be seen after a mean follow-up period of 62 months. Thrombolysis was complicated in 4 patients (5.6%) by macroembolizations but no major bleedings or deaths occurred. Primary patency was 76%, 64%, and 43% after 1, 5 and 10 years. Male sex and distal localization were significantly correlated with lower primary clinical patency.

Systemic lysis therapy is an alternative to surgical intervention in acute and subacute aorto-iliac occlusive disease, because it offers acceptable long-term results with a low rate of complications.