[Local thrombolysis in peripheral arterial occlusion].

Area of Science:

• Vascular Medicine
• Thrombolytic Therapy
• Biochemistry

Context:

• Peripheral arterial occlusions are primarily caused by thrombosis or embolism.
• Spontaneous clot lysis is limited, especially in arteriosclerotic vessels.
• Systemic thrombolytic therapy with streptokinase (SK) and urokinase (UK) has historical efficacy but significant risks.

Purpose:

• To review the efficacy and safety of thrombolytic agents for peripheral arterial occlusions.
• To compare systemic versus local administration of thrombolytics.
• To evaluate recombinant tissue plasminogen activator (rt-PA) in this context.

Summary:

• Systemic SK/UK treatment for occlusions up to six weeks old achieved 48% lysis but carried a 7% risk of severe bleeding (1.12% fatal).
• Local administration of SK, UK, and rt-PA allows for effective clot dissolution within hours.
• Low-dose local therapy with SK (≤30,000 units), UK (100,000-300,000 units), and rt-PA (2.5-7.5 mg) demonstrated no bleeding complications in over 300 patients.

Impact:

• Local thrombolysis represents a safer and effective alternative to systemic administration for peripheral arterial occlusions.
• Optimized dosing strategies for thrombolytic agents minimize adverse events.
• Advancements in genetic engineering have enabled the development of targeted therapies like rt-PA.