Cost-effectiveness of intra-arterial thrombolytic therapy

We reviewed the clinical course of 23 patients who received 24 intra-arterial infusions of either streptokinase or urokinase to treat 14 arteries and ten arterial grafts that were occluded due to primary thrombosis (22) or artery-artery embolism (two). Time from symptom onset to treatment was one to 28 days (mean, 11 days). Five infusions (21%) were completely successful since symptoms were eliminated without subsequent operation. Seven infusions (29%) were partially successful since thrombolysis aided, limited, or postponed subsequent surgery. Six infusions (25%) were failures since thrombolysis or clinical improvement did not occur and surgery was required. Six infusions (25%) were associated with thrombolytic complications that required urgent operation (less severe complications occurred in an additional 17% of cases [4/24]). Of the 19 patients without complete success after thrombolytic therapy, 16 underwent surgery during the same admission, two were not operable due to distal disease, and one declined operation. Of the 16 operations, 15 (94%) were successful in restoring graft or artery patency and achieving limb salvage, whereas one failed. In the 12 patients with failure or major complications of thrombolytic treatment, all had successful surgical outcome without morbidity. The actual mean cost of thrombolytic treatment was $8200 per patient and was comparable with the actual mean cost of subsequent surgical treatment in the 16 patients who required operation ($8900 per patient). The effective cost of thrombolytic and surgical treatment was calculated by dividing the actual costs by the proportion of successful cases. The effective cost of thrombolytic therapy per complete success was $39,200 and per complete or partial success was $16,500. This was significantly more than the effective cost of $9400 per complete success of surgical therapy.