Thrombolysis and thromboaspiration for acute thromboembolic occlusion in the upper extremity

To report technical aspects of thrombolysis and thromboaspiration for acute thromboembolic occlusion in the upper extremity.

This study included four consecutive patients with acute thromboembolic occlusion in the upper extremity (right arm, n = 3; left arm n = 1). The mean patient age was 81.3 ± 11.5 years (mean ± standard deviation; range 69-92 years) and all patients had chronic atrial fibrillation. Emergent angiography was performed via the femoral artery.

Thromboembolic occlusion was demonstrated in the axillary artery (n = 2), axillary and radial arteries (n = 1), and brachial, radial, and ulnar arteries (n = 1). Endovascular treatment was performed via the unaffected brachial (n = 3) or radial artery (n = 1). Thrombolysis was performed for three patients using 360,000-480,000 IU (mean 400,000 ± 69,000 IU) urokinase, including 12-h continuous infusion in one. Thromboaspiration was performed in all four patients using a 6F catheter. Recanalization was achieved in all patients and all arms were salvaged. Perforation of the small branch during guidewire manipulation was successfully managed by placement of a microcoil.

The combination of thrombolysis and thromboaspiration is effective for acute thromboembolic occlusion in the upper extremity.