Intraoperative fibrinolytic therapy: experimental evaluation.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Thrombolytic Therapy

Background:

• Acute arterial occlusions pose significant clinical challenges.
• Fibrinolytic agents delivered via percutaneous intra-arterial infusion offer an alternative to surgical embolectomy.
• Combining fibrinolytic therapy with embolectomy may enhance treatment efficacy.

Purpose of the Study:

• To evaluate the safety and efficacy of intraoperative fibrinolytic therapy as an adjunct to catheter embolectomy.
• To compare outcomes of catheter embolectomy alone versus combined therapy in a canine model of acute arterial occlusion.

Main Methods:

• Forty canine hind limbs were subjected to induced thrombus formation and subsequent embolectomy after 24 hours.
• Experimental groups received intra-arterial infusions of streptokinase (SK) with or without heparin, or saline (control), over 30 or 60 minutes.
• Arteriograms and blood flow measurements were assessed before and after intervention.

Main Results:

• Angiographic improvement was observed in 20% of control limbs versus 100% with SK plus heparin and 80% with SK alone (p<0.01).
• A trend towards increased blood flow was noted in experimental groups.
• No intraoperative or significant postoperative bleeding complications occurred during the 36-hour observation period.

Conclusions:

• Intraoperative fibrinolytic therapy, particularly with streptokinase, is a safe and effective adjunct to thromboembolectomy in a canine model.
• The combination therapy demonstrated superior results compared to embolectomy alone.
• Further investigation in human clinical trials is recommended to translate these findings.