[Systemic and regional fibrinolytic treatment of peripheral arterial occlusions: proven indications?]

Catheter-based treatment of intraarterial thrombus can be used successfully as a treatment to recanalize acutely occluded native arteries or bypasses associated with acute limb ischaemia. It should be used if the ischaemia not already caused sensory and/or paralytic disorders that require urgent open surgical treatment. Advantages of pursuing immediate angiography in patients with acute limb ischaemia include delineation of the limb arterial anatomy with visualization of both inflow and runoff vessels and clearing intraarterial thrombus from the distal runoff vessels. Thus, final treatment can be planned electively as an intervention of open surgery. A metaanalysis comparing lysis and surgery that included three randomized trials and case series concluded that lysis improved 6 to 12 months limb salvage and reduced mortality compared with surgery. The transformation of an acute arterial occlusion into a chronic one is not clearly defined. Thus, fibrinolytic therapy can be successfully used for occlusions supposed to be older than six months.