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Outcome of intraarterial urokinase for acute vascular occlusion
F N Parent1, J J Piotrowski, V M Bernhard
1Department of Surgery, University of Arizona Health Sciences Center, Tucson.
Insights
Intraarterial urokinase (IAUK) effectively clears thrombus in acute extremity ischemia, achieving 95% lysis success. However, long-term patency varies significantly, with native arteries showing superior results compared to grafts.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombolytic Therapy
Background:
- Acute extremity ischemia poses a significant risk of limb loss.
- Intraarterial thrombolysis is a key treatment modality.
- Assessing the long-term efficacy of intraarterial urokinase (IAUK) is crucial.
Purpose of the Study:
- To evaluate the effectiveness and long-term patency of IAUK in treating acute extremity ischemia.
- To compare IAUK outcomes across different types of vascular occlusions (native arteries, autologous vein grafts, synthetic grafts).
Main Methods:
- Retrospective analysis of 40 IAUK treatments in 33 patients with acute extremity ischemia.
- Assessment of immediate thrombus lysis success.
- Evaluation of primary cumulative patency rates at various time points (9 and 12 months).
- Analysis of rethrombosis rates for different graft types.
Main Results:
- Successful thrombolysis was achieved in 39 of 40 cases (95%).
- Complete or partial thrombus clearance was observed in native arteries, autologous vein grafts, and synthetic grafts.
- Primary cumulative patency at 12 months was 100% for native arteries, 47% for synthetic grafts, and 23% at 9 months for autologous grafts.
- Rethrombosis rates were significantly higher for autologous vein (67%) and synthetic grafts (63%) compared to native arteries (0%).
Conclusions:
- IAUK demonstrates high immediate success in clearing thrombus for acute extremity ischemia.
- IAUK is most effective for native artery occlusions, offering excellent long-term patency.
- IAUK has limited long-term efficacy for thrombosed infrainguinal autologous vein or synthetic grafts due to high reocclusion rates.
- Incomplete lysis and rapid patency deterioration are common issues with IAUK in autologous vein grafts.
Abstract:
Intraarterial urokinase (IAUK) was administered to 33 patients on 40 occasions for the treatment of acute extremity ischemia and long-term patency was assessed. Lysis was successful in 39 of the 40 cases (95%). Occlusive thrombus was cleared in 12 of 13 patients with native artery occlusion (7 complete, 5 partial), 8 of 9 with autologous vein grafts (5 complete, 3 partial), and in all 18 patients with synthetic grafts (17 complete, 1 partial). The primary cumulative patency following successful IAUK was 100% for native arteries and 47% for synthetic grafts at 12 months, and 23% for autologous grafts at 9 months. The difference in rethrombosis rate between autologous vein (67%) and native artery (0%) was significant (p = 0.02) as was the difference between infrainguinal prosthetic grafts (63%) and native artery (p = 0.025). IAUK is most effective for the treatment of native artery occlusion, but is significantly less effective for thrombosed infrainguinal autologous vein or synthetic grafts due to the likelihood of reocclusion, despite the high immediate success rate. For autologous vein grafts, lysis is frequently incomplete and patency rapidly deteriorates regardless of adjunctive therapy to relieve the underlying obstruction.