Selective management of arterial occlusion with low-dose streptokinase

Fibrinolytic therapy has been reported as a limited aid in limb salvage. It is allegedly fraught with complications and pitfalls; however, the usage of low-dose streptokinase has never totally been explored. The purpose of this study was to examine the role of low-dose streptokinase in arterial occlusion. Nineteen patients (12 men and 7 women) with an average age of 68 years (range 37 to 79 years) and a total of 22 limbs under study were treated with low-dose streptokinase (initial intravenous dose of 10,000 units and a subsequent dose of 5,000 to 10,000 units/hour) for 1 to 3 days. Seven of the patients underwent further operative intervention and four underwent angioplasty. Seven patients had diabetes controlled by insulin. Results were assessed clinically by angiography and by noninvasive measurement of distal pressure. Within 30 days of low-dose streptokinase therapy, four patients died from a myocardial infarction that was thought to be part of their total disease process. Limited salvage occurred in 19 of 22 limbs at risk. Ten patients (12 extremities) underwent subsequent balloon angioplasty or bypass surgery. There were three amputations. One patient received a below-knee amputation rather than an expected above-knee amputation, one had a below-knee amputation, and one had an above-knee amputation. In all cases, the patency or lack thereof was confirmed by angiography. The mean ankle to brachial pressure indices increased from 0.07 +/- 0.15 to 0.64 +/- 0.14 after therapy. There were no prolonged hospital stays due to complications in any of the patients. Selective infusions of low-dose streptokinase lyse thrombi, open collaterals, and provide an opportunity for extended surgery and angioplasty, increasing limb salvage without the risks of coagulopathy and bleeding that may occur in full-dose thrombolysis.